Evidence based observations suggest that elderly population has usually poor prognosis in cases of acute liver failure (ALF) and might be considered a relative contraindication for liver transplantation for ALF. The objective of the current study was to determine the effects of older age > or = 60 years, on clinical outcomes in patients with ALF. 

The study enrolled 1126 consecutive prospective patients from the Acute Liver Failure Study Group registry. The median age of these patients was 38 years (range, 15-81 years). The results demonstrated that 1016 patients (90.2%) were younger than 60 years; categorized as group 1, and 499 (49.1%) of these group 1 had acetaminophen-induced ALF. In addition, the rate of acetaminophen-induced ALF was remarkably higher than that in patients > or = 60 years (cnsidered as group 2; 23.6% with acetaminophen-induced ALF). The overall survival rate was found to be 72.7% and 60.0% in group 1 and group 2 for acetaminophen patients while 67.9% and 48.2% in group 1 and  group 2 for non-acetaminophen patients, respectively. The spontaneous survival rate, survival considered without liver transplantation was 64.9% and 60.0% in group 1 and group 2 for acetaminophen patients and 30.8% and 24.7% in group 1 and group 2 for non-acetaminophen patients. When assessed from multiple logistic regression analyses, age was not a significant predictor of spontaneous survival and was considered as a contraindication for transplantation in 5 patients. Furthermore, group 2 patients required liver transplantation remarkably less in contrast to group 1 patients. 

Thus, the evidences concluded that when the etiology of ALF is managed, even older patients with ALF can exhibit a good spontaneous survival rate. In addition, it can be assumed that overall survival can be better for younger non-acetaminophen patients, but fewer older patients requires liver transplantation.

Source: Frank VS, Chung RT, Schilsky ML, Hay JE, Christensen E, William ML. Outcome of Acute Liver Failure in the Elderly. Liver transplantation. 2009;15(11):1481-7.