Evolving Role of Liver Transplantation in Elderly Recipients

Omar Y. Mousa, Justin H Nguyen, Yaohua Ma, Bhupendra Rawal, Kaitlyn R. Musto, Marjorie K. Dougherty, Jefree A. Shalev, Denise Harnois

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Abstract

The need for liver transplantation (LT) among older patients is increasing, but the role of LT in the elderly (≥70 years) is not well defined. We retrospectively reviewed all primary LTs from 1998 through 2016 at our center. Survival and associated risk factors were analyzed with Cox regression and Kaplan-Meier methods for LT recipients in 3 age groups: <60, 60-69, and ≥70 years. Among 2281 LT recipients, the median age was 56 years (range, 15-80 years), and 162 were aged ≥70 years. The estimated 5- and 10-year patient survival probabilities for elderly LT recipients were lower (70.8% and 43.6%) than for recipients aged 60-69 years (77.2% and 64.6%) and <60 years (80.7% and 67.6%). Patient and graft survival rates associated with LT improved over time from the pre–Model for End-Stage Liver Disease era to Share 15, pre–Share 35, and Share 35 for the cohort overall (P < 0.001), but rates remained relatively stable in septuagenarians throughout the study periods (all P > 0.45). There was no incremental negative effect of age at LT among elderly patients aged 70-75 years (log-rank P = 0.32). Among elderly LT recipients, greater requirement for packed red blood cells and longer warm ischemia times were significantly associated with decreased survival (P < 0.05). Survival of LT recipients, regardless of age, markedly surpassed that of patients who were denied LT, but it was persistently 20%-30% lower than the expected survival of the general US population (P < 0.001). With the aging of the population, select older patients with end-stage liver diseases can benefit from LT, which largely restores their expected life spans.

Original languageEnglish (US)
Pages (from-to)1363-1374
Number of pages12
JournalLiver Transplantation
Volume25
Issue number9
DOIs
StatePublished - Jan 1 2019

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ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Mousa, O. Y., Nguyen, J. H., Ma, Y., Rawal, B., Musto, K. R., Dougherty, M. K., Shalev, J. A., & Harnois, D. (2019). Evolving Role of Liver Transplantation in Elderly Recipients. Liver Transplantation, 25(9), 1363-1374. https://doi.org/10.1002/lt.25589