Liver Transplantation in Elderly Recipients: Is Age Just a Number?
Joshua Kurian1, Lauren Matevish1, Cyrus Feizpour1, Jigesh Shah1, Christine Hwang1, Susan Neill-Fogus1, Steven Hanish1, Arjmand Mufti2, Parsia Vagefi1, Madhukar S. Patel1
1Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States, 2Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas, United States
Objective: The proportion of older patients on the liver transplant waitlist has continued to increase and represents over 20%. With limited existing data to guide decisions regarding liver transplant evaluation and listing of elderly patients, we aimed to study selection practices and outcomes of patients ≥70 years old. We hypothesized that outcomes including 1-year survival would not differ between appropriately selected elderly patients and those who are younger.
Design: Retrospective cohort study with a median follow-up of 16.4 months.
Setting: Large academic transplant center
Patients: All patients referred for liver transplantation between 2018-2020 were stratified into elderly (age ≥70) and young (age <70) cohorts. Evaluation data pertaining to medical, psychosocial, and surgical risk assessment were reviewed. Recipient characteristics and post-operative outcomes were compared between those undergoing transplant.
Main Outcome Measures: Patient and graft survival at one-year post-transplant.
Results: 2,331 patients were referred for transplant evaluation, of which 349 were ≥70 years old. 32 (9.2%) of the elderly patients were listed. During the study period, 322 patients underwent transplant (20 [6.2%] elderly). The most common reasons for listing denial of elderly patients were medical comorbidities (49%) followed by cardiac risk (15%) and psychosocial barriers (13%). The median lab MELD of elderly recipients was lower (19 vs 24, p=0.02), with a higher proportion having hepatocellular carcinoma (60% vs 23%, p<0.001). Extubation rates, length of stay, complications, readmissions, survival, and costs were similar between groups. There was similarly no difference in the 1-year graft (elderly 90.9% vs young 93.3%, p=0.72) or patient survival (elderly 90.9% vs young 94.7, p=0.88).
Conclusions: Liver transplant outcomes and survival are not affected by elderly age in carefully evaluated and selected recipients. As the number of elderly patients with end stage liver disease continues to rise, efforts should be made to develop guidelines for risk stratification and donor-recipient matching that optimizes outcomes in this potentially higher risk group of patients.
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