Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 475

Liver transplantation is often the best treatment for advanced cirrhosis, acute hepatic failure, and some liver cancers. Carefully selected patients over 65 have a good prognosis, with five‐year survival of about 80%. In a study from the Mayo Clinic comparing 42 patients over 70 to 42 matched patients younger than 60, five‐year survival was identical.⁴¹

The decision of when to offer a transplant to a cirrhotic patient is based on the Model for End‐stage Liver Disease (MELD). The MELD looks at several parameters in a mathematical formula to grade the cirrhotic patient’s life expectancy. Those parameters are creatinine, sodium, bilirubin, and INR. There are multiple online MELD calculators; when the MELD score is 17, a patient is likely to do better with a transplant than without one. We usually refer patients whose MELD is greater than 15 to a transplant clinic if they are a reasonable candidate. Reasonable candidates are people who are otherwise healthy in terms of no cancers, dementia, or cardiovascular disease; they can have kidney disease, as they can be listed for combined transplants. In the geriatric population over age 70, they should have a good performance status and stable and supportive home life and be likely to live 10 years with a transplant.