Liver transplantation in elderly patients: a systematic review and first meta-analysis.Gomez Gavara, C., Esposito, F et al. (2019).
HPB 21(1): 14-25.
The aim of this study was to synthesize the available evidence on liver transplantation for elderly patients to assess graft and patient survival.
A literature search of the Medline, EMBASE, and Scopus databases was carried out from January 2000 to August 2018.
22 studies were included involving a total of 242,487 patients.
The primary outcomes assessed were patient mortality and graft loss rates. The secondary outcomes were perioperative morbidity and 90-day mortality.
This is an interesting systematic review and meta-analysis in liver transplantation that compares the outcomes for adults older than 65 years with those of adults under 65 years. The primary outcomes were 1- and 5-year patient and graft survival. The systematic review was prospectively registered, and searches were conducted in multiple databases, resulting in 22 included studies. Eight studies were registry analyses, 2 were comparative studies and 12 were retrospective single-centre databases, including in total over 240,000 patients. Articles were screened by two reviewers independently. Three quarters of the studies included were of low quality and the remaining quarter were of very low quality according to the review authors’ assessments. The definition of elderly in included studies ranged from over 63 years to over 75 years, so only 7 studies could be included in the meta-analysis with a threshold of 65 years. In this analysis there was moderate heterogeneity (I-squared = 48%) and older patients had a Hazard Ratio of 1.26 for survival although it was not statistically different in this reduced sample (HR range 0.97-1.63, p=0.09). Graft loss was not significantly different also, but studies did not clearly define how this was assessed. The key point is that it was not possible to know how each included study assessed patients as being suitable for transplantation, ie what is their physiological age? The older group did have a significantly lower MELD score in half the studies reporting this variable, so it may be that a more conservative approach was being taken with older recipients.
Systematic review – Quality assessment not appropriate.
PROSPERO - CRD42017058261