Trends and outcomes of liver transplantation among older recipients in the United States

BACKGROUND The average age of recipients and donors of liver transplantation(LT) is increasing. Although there has been a change in the indications for LT over the years, data regarding the trends and outcomes of LT in the older population is limited.AIM To assess the clinical characteristics, age-related trends, and outcomes of LT among the older population in the United States.METHODS We analyzed data from the United Network for Organ Sharing database between 1987-2019. The sample was split into younger group(18-64 years old) and older group(≥ 65 years old).RESULTS Between 1987-2019, 155758 LT were performed in the United States. During this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased(P < 0.05) with the highest incidence of LT among older population seen in 2019(1920, 23%). Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group, were non-alcoholic steatohepatitis(16.4% vs 5.9%), hepatocellular carcinoma(14.9% vs 6.9%), acute liver failure(2.5% vs 5.2%), hepatitis C cirrhosis(HCV)(19.2 % vs 25.6%) and acute alcoholic hepatitis(0.13% vs 0.35%). In older recipient group female sex and Asian race were higher, while model for end-stage liver disease(MELD) score and rates of preoperative mechanical ventilation were lower(P < 0.01). Median age of donor, female sex, body mass index(BMI), donor HCV positive status, and donor risk index(DRI) were significantly higher in older group(P < 0.01). In univariable analysis, there was no difference in post-transplant length of hospitalization, one-year, three-year and five-year graft survivals between the two groups. In multivariable CoxHazard regression analysis, older group had an increased risk of graft failure during the five-year post-transplant period(hazard ratio: 1.27, P < 0.001). Other risk factors for graft failure among recipients were male sex, African American race, re-transplantation, presence of diabetes, mechanical ventilation at the time of LT, higher MELD score, presence of portal vein thrombosis, HCV positive status, and higher DRI.CONCLUSION While there is a higher risk of graft failure in older recipient population, age alone should not be a contraindication for LT. Careful selection of donors and recipients along with optimal management of risk factors during the postoperative period are necessary to maximize the transplant outcomes in this population.