Outcome of acute liver failure in the elderly

Older age is considered a poor prognostic factor in acute liver failure (ALF) and may still be considered a relative contraindication for liver transplantation for ALF. We aimed to evaluate the impact of older age, defined as age ≥ 60 years, on outcomes in patients with ALF. One thousand one hundred...

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Bibliographic Details
Published in:Liver transplantation 2009-11, Vol.15 (11), p.1481-1487
Main Authors: Schiødt, Frank V., Chung, Raymond T., Schilsky, Michael L., Hay, J. Eileen, Christensen, Erik, Lee, William M.
Format: Article
Language:English
Subjects:
Acetaminophen - poisoning
Adolescent
Adult
Age Distribution
Aged
Analgesics, Non-Narcotic - poisoning
Female
Humans
Liver Failure, Acute - chemically induced
Liver Failure, Acute - mortality
Liver Failure, Acute - surgery
Liver Transplantation - mortality
Male
Middle Aged
Prognosis
Registries
Survival Analysis
Young Adult
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Summary:Older age is considered a poor prognostic factor in acute liver failure (ALF) and may still be considered a relative contraindication for liver transplantation for ALF. We aimed to evaluate the impact of older age, defined as age ≥ 60 years, on outcomes in patients with ALF. One thousand one hundred twenty‐six consecutive prospective patients from the US Acute Liver Failure Study Group registry were studied. The median age was 38 years (range, 15–81 years). One thousand sixteen patients (90.2%) were younger than 60 years (group 1), and 499 (49.1%) of these had acetaminophen‐induced ALF; this rate of acetaminophen‐induced ALF was significantly higher than that in patients ≥ 60 years (group 2; n = 110; 23.6% with acetaminophen‐induced ALF, P < 0.001). The overall survival rate was 72.7% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 67.9% in group 1 and 48.2% in group 2 for non‐acetaminophen patients (P < 0.001). The spontaneous survival rate (ie, survival without liver transplantation) was 64.9% in group 1 and 60.0% in group 2 (not significant) for acetaminophen patients and 30.8% in group 1 and 24.7% in group 2 for non‐acetaminophen patients (P = 0.27). Age was not a significant predictor of spontaneous survival in multiple logistic regression analyses. Group 2 patients were listed for liver transplantation significantly less than group 1 patients. Age was listed as a contraindication for transplantation in 5 patients. In conclusion, in contrast to previous studies, we have demonstrated a relatively good spontaneous survival rate for older patients with ALF when it is corrected for etiology. However, overall survival was better for younger non‐acetaminophen patients. Fewer older patients were listed for transplantation. Liver Transpl 15:1481–1487, 2009. © 2009 AASLD.
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.21865