Impact of age on the incidence of complications after liver transplantation: A single-center retrospective study
Impacto da idade na incidência de complicações após o transplante de fígado: um estudo retrospectivo de centro único
Ju Yeon Park, Yoon Ji Choi, Hyun-Su Ri, Jung Min Lee, Hyo Jung Son, Yoon Sook Lee, Je ho Ryu, Kwang Ho Yang
Abstract
Background and objective
Advances in surgical technique, postoperative management, and immunosuppressive therapy have led to a steady increase in the number of patients undergoing organ transplantation. This study aimed to compare the incidence of postoperative complications between young and elderly patients undergoing liver transplantation (LT) at a single university hospital.
Method
The medical records of 253 patients who underwent LT between January 2010 and July 2017 were retrospectively reviewed. The patients were divided into two groups: those younger than 65 years (group Y, n = 231) and those older than 65 years (group O, n = 22). Data on patient demographics, perioperative management, and postoperative complications were collected.
Results
The patients’ baseline characteristics, including underlying diseases and the Model for End-Stage Liver Disease scores, were not different between groups. Preoperative laboratory findings were not significantly different between the two groups, except for hemoglobin level. The total amounts of infused fluid and packed red blood cells were higher in group O than in group Y. The postoperative plasma creatinine level was higher in group O than in group Y; however, the incidence of postoperative complications was not considerably different between the two groups. In addition, there was no difference in the survival rate after LT depending on age.
Conclusion
With the development of medical technology, LT in elderly patients is not an operation to be avoided, and the prognosis is expected to improve. Therefore, continuous efforts to understand the disease characteristics and physical differences in elderly patients who require LT are essential.
Keywords
Resumo
Justificativa e objetivo: Os avanços na técnica cirúrgica, no acompanhamento pós-operatório e na terapia imunossupressora levaram a um aumento constante no número de pacientes submetidos ao transplante de órgãos. O objetivo deste estudo foi comparar a incidência de complicações pós-operatórias entre pacientes jovens e idosos submetidos ao transplante hepático (TH) em um único hospital universitário. Método: Os prontuários de 253 pacientes submetidos a TH entre janeiro de 2010 e julho de 2017 foram revisados retrospectivamente. Os pacientes foram divididos em dois grupos: menores de 65 anos (grupo Y, n = 231) e maiores de 65 anos (grupo O, n = 22). Dados sobre dados demográficos do paciente, acompanhamento perioperatório e complicações pós-operatórias foram coletados. Resultados: as características basais dos pacientes, incluindo doenças subjacentes e os escores do modelo para doença hepática em estágio terminal, não foram diferentes entre os grupos. Os achados laboratoriais pré-operatórios não foram significativamente diferentes entre os dois grupos, exceto para o nível de hemoglobina. As quantidades totais de fluido infundido e concentrado de hemácias foram maiores no grupo O do que no grupo Y. O nível de creatinina plasmática pós-operatória foi maior no grupo O do que no grupo Y; no entanto, a incidência de complicações pós-operatórias não foi consideravelmente diferente entre os dois grupos. Além disso, não houve diferença na taxa de sobrevivência após o TH dependendo da idade. Conclusão: Com o desenvolvimento da tecnologia médica, o TH em pacientes idosos não é uma operação a ser evitada e espera-se que o prognóstico melhore. Portanto, esforços contínuos para compreender as características da doença e diferenças físicas em pacientes idosos que necessitam de TH são essenciais.
Palavras-chave
References
[1] L.S. Yang, L.L. Shan, A. Saxena, et al. Liver transplantation: a systematic review of long-term quality of life Liver Int., 34 (2014), pp. 1298-1313
[2] E.B. Keeffe Liver transplantation: current status and novel approaches to liver replacement Gastroenterology., 120 (2001), pp. 749-762
[3] A.S. Yu, A. Ahmed, E.B. Keeffe Liver transplantation: evolving patient selection criteria Can J Gastroenterol., 15 (2001), pp. 729-738
[4] B.H. Collins, J.D. Pirsch, Y.T. Becker, et al. Long-term results of liver transplantation in older patients 60 years of age and older Transplantation., 70 (2000), pp. 780-783
[5] J. Showstack, P.P. Katz, J.R. Lake, et al. Resource utilization in liver transplantation: effects of patient characteristics and clinical practice NIDDK Liver Transplantation Database Group. JAMA., 281 (1999), pp. 1381-1386
[6] C.L. Berg, D.E. Steffick, E.B. Edwards, et al. Liver and intestine transplantation in the United States 1998-2007 Am J Transplant., 9 (2009), pp. 907-931
[7] A.I. Sutherland, J.N. IJzermans, J.L. Forsythe, et al. Kidney and liver transplantation in the elderly Br J Surg., 103 (2016), pp. e62-e72
[8] H.Y. Li, Y.G. Wei, L.N. Yan, et al. Outcomes Between Elderly and Young Hepatocellular Carcinoma Living Donor Liver Transplantation Recipients: A Single-Center Experience Medicine (Baltimore)., 95 (2016), p. e2499
[9] H.P. Chen, Y.F. Tsai, J.R. Lin, et al. Recipient Age and Mortality Risk after Liver Transplantation: A Population-Based Cohort Study PLoS One., 11 (2016), p. e0152324
[10] A. Akdur, C. Fidan, E. Ayvazoglu Soy, et al. Results of liver transplant in elderly patients: a single center experience Exp Clin Transplant., 13 (Suppl 1) (2015), pp. 124-126
[11] A. Sonny, D. Kelly, J.P. Hammel, et al. Predictors of poor outcome among older liver transplant recipients Clin Transplant., 29 (2015), pp. 197-203
[12] R.L. Mehta, J.A. Kellum, S.V. Shah, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury Crit Care., 11 (2007), p. R31
[13] G. Contreras, G. Garces, A.A. Quartin, et al. An epidemiologic study of early renal replacement therapy after orthotopic liver transplantation J Am Soc Nephrol., 13 (2002), pp. 228-233
[14] M.S. Campbell, D.S. Kotlyar, C.M. Brensinger, et al. Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation Liver Transpl., 11 (2005), pp. 1048-1055
[15] S. Niazi, T. Schneekloth, C.B. Taner Elderly recipients of liver transplantation: impact of age and psychosocial variables on outcome Curr Opin Organ Transplant., 22 (2017), pp. 588-592
[16] R.N. Keswani, A. Ahmed, E.B. Keeffe Older age and liver transplantation: a review Liver Transpl., 10 (2004), pp. 957-967
[17] S.H. Yi, H.M. Yi, B.S. Fu, et al. Long-term results of liver transplantation for over 60 years old patients with hepatitis B virus-related end-stage liver disease Hepatobiliary Pancreat Dis Int., 13 (2014), pp. 501-507
[18] E. Slattery, J.E. Hegarty, P.A. McCormick It's a man's world: does orthotopic liver transplantation in the elderly male confer an additional risk on survival? Can J Gastroenterol., 26 (2012), pp. 697-700
[19] H. Ushigome, T. Nakao, S. Harada, et al. Elderly Living Donor Liver Transplant Recipients Over 60 Years Old at a Japanese Single Center Transplant Proc., 48 (2016), pp. 1115-1118
[20] T. Shimagaki, T. Yoshizumi, K. Kimura, et al. Living Donor Liver Transplantation in an Elderly Recipient with Preserved Performance Status: A Case Report Fukuoka Igaku Zasshi., 107 (2016), pp. 115-120
[21] K.P. Croome, D.D. Lee, J.M. Burns, et al. Simultaneous liver and kidney transplantation in elderly patients: Outcomes and validation of a clinical risk score for patient selection Ann Hepatol., 15 (2016), pp. 870-880
[22] G.C. Wilson, R.C. Quillin 3rd, K. Wima, et al. Is liver transplantation safe and effective in elderly (>/=70 years) recipients?. A case-controlled analysis HPB (Oxford)., 16 (2014), pp. 1088-1094
[23] J.J. Schwartz, L. Pappas, H.F. Thiesset, et al. Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: the national experience Liver Transpl., 18 (2012), pp. 423-433
[24] B.L. Ecker, K.D. Simmons, S. Zaheer, et al. Blood Transfusion in Major Abdominal Surgery for Malignant Tumors: A Trend Analysis Using the National Surgical Quality Improvement Program JAMA Surg., 151 (2016), pp. 518-525
[25] M.T. de Boer, M.C. Christensen, M. Asmussen, et al. The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation Anesth Analg., 106 (2008), pp. 32-44 table of contents
[26] A. Avall, M. Hyllner, J.P. Bengtson, et al. Postoperative inflammatory response after autologous and allogeneic blood transfusion Anesthesiology., 87 (1997), pp. 511-516
[27] E. Fransen, J. Maessen, M. Dentener, et al. Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery Chest., 116 (1999), pp. 1233-1239
[28] R.W. Chu Leukocytes in blood transfusion: adverse effects and their prevention Hong Kong Med J., 5 (1999), pp. 280-284
[29] G.N. Tzimas, M. Deschenes, J.S. Barkun, et al. Leukoreduction and acute rejection in liver transplantation: an interim analysis Transplant Proc., 36 (2004), pp. 1760-1762
[30] A.B. Narvios, M. de Lima, H. Shah, et al. Transfusion of leukoreduced cellular blood components from cytomegalovirus-unscreened donors in allogeneic hematopoietic transplant recipients: analysis of 72 recipients Bone Marrow Transplantation., 36 (2005), pp. 499-501
[31] L.M. van de Watering, J. Hermans, J.G. Houbiers, et al. Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial Circulation., 97 (1998), pp. 562-568
[32] T.J. Cross, C.G. Antoniades, P. Muiesan, et al. Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival Liver Transpl., 13 (2007), pp. 1382-1388
[33] J.H. Han, Y.K. You, G.H. Na, et al. Outcomes of living donor liver transplantation using elderly donors Ann Surg Treat Res., 86 (2014), pp. 184-191
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