Outcome of acute liver failure in the elderly

Frank V. Schiødt, Raymond T. Chung, Michael L. Schilsky, J. Eileen Hay, Erik Christensen, William M. Lee, George A. Ostapowicz, Julie Polson, Anne M. Larson, Timothy Davern, Timothy McCashland, Natalie Murray, A. Obaid S Shaikh, Andres Blei, Atif Zaman, Steven H B Han, Robert Fontana, Brendan McGuire, Ray Chung, Alastair SmithRobert Brown, Jeffrey Crippin, Edwin Harrison, Adrian Reuben, Santiago Munoz, Rajender Reddy, R. Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1481-1487
Number of pages7
JournalLiver Transplantation
Volume15
Issue number11
DOIs
StatePublished - Nov 2009

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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    Schiødt, F. V., Chung, R. T., Schilsky, M. L., Hay, J. E., Christensen, E., Lee, W. M., Ostapowicz, G. A., Polson, J., Larson, A. M., Davern, T., McCashland, T., Murray, N., Shaikh, A. O. S., Blei, A., Zaman, A., Han, S. H. B., Fontana, R., McGuire, B., Chung, R., ... Hassanein, T. (2009). Outcome of acute liver failure in the elderly. Liver Transplantation, 15(11), 1481-1487. https://doi.org/10.1002/lt.21865