Older age is deemed a poor prognostic factor in acute liver failure (ALF) and thus can be seen as a relative contraindication for liver transplantation for ALF. Thus a study evaluated the impact of older age [>/= 60 years] on outcomes in patients with ALF. It enrolled 1126 consecutive prospective patients from the US Acute Liver Failure Study Group registry.

The observations of the study were as follows-

• The median age was 38 years (ranging between 15 and 81 years). 
• 1016 (90.2%) were <60 years (group 1), and 499 (49.1%) among these had acetaminophen-induced ALF 
• Group 2 comprised of 110 patients with 23.6% having acetaminophen-induced ALF. 
• Rate of acetaminophen-induced ALF was significantly higher in patients aged <60years of age than patients >/= 60 years.
• The overall survival rate was 72.7% and 60.0% in groups 1 and 2 respectively for acetaminophen patients
• The overall survival rate was 67.9% and 48.2% in groups 1 and 2 respectively for non-acetaminophen patients. 
• The spontaneous survival rate (i.e. survival without liver transplantation) was 64.9% and 60.0% in groups 1 and 2 respectively (not significant) for acetaminophen patients 
• The spontaneous survival rate was 30.8% and 24.7% in groups 1 and 2 respectively for non-acetaminophen patients. 
• Multiple logistic regression analyses do not show age as a significant predictor of spontaneous survival.
• Group 1 patients have listed more than Group 2 patients for liver transplantation. 
• Age came as a contraindication for transplantation in 5 patients. 

In conclusion, a relatively good spontaneous survival rate for older patients with ALF is seen when it is corrected for etiology. However, overall survival remains better for younger non-acetaminophen patients and fewer older patients get transplantation.

Source: Schiødt FV, Chung RT, Schilsky ML, Hay JE, Christensen E, Lee WM. The outcome of Acute Liver Failure in the Elderly, Liver Transplantation, November 2009;15(11):1481-7. DOI:10.1002/lt.21865