ADVANCING LIVER TRANSPLANTATION INTO THE NEXT DECADE: LIVER TRANSPLANT OUTCOMES IN PATIENTS 70 YEARS OR OLDER

Document Type

Conference Proceeding

Publication Date

10-9-2024

Publication Title

Hepatology

Abstract

Background: Since the introduction of direct-acting antivirals for hepatitis C virus, liver transplantation (LT) has undergone a change in patient demographics, with patients receiving increasingly more LT for other chronic liver diseases and at older ages. Historically, younger patients have been prioritized for LT due to concerns about post-transplant outcomes in older patients; however, emerging evidence suggests that the impact of age on transplant eligibility criteria may need to be reevaluated. This study describes the clinical characteristics and postoperative LT outcomes of patients ≥ 70 years compared to patients < 70 years old. Methods: Single center retrospective chart review of all patients who underwent LT at a high-volume academic transplant center between January 1, 2014, and September 26, 2023. Results: Of 999 liver transplant recipients (36% women; 64% men), 43 were ≥ 70 years old (median 71 y; range 70-75) and 956 were < 70 years old (median 58 y; range 16-69). The older group had more baseline comorbidities but a lower median MELD at LT (21 vs 25; p =.014). Indications for LT differed between groups; while the younger group had a higher rate of alcoholic cirrhosis (39% vs 14%; p = < .001), the older group had greater proportions of patients with metabolic dysfunction-associated steatohepatitis (51% vs 23%; p = <.001), primary biliary cholangitis (9.3% vs 2.8%; p= .040), and cryptogenic cirrhosis (14% vs 5%; p= .022). Older and younger patients had similar postoperative liver function laboratory values, biliary complication rates, need for further procedures, and hospital readmission. The older cohort had a significantly longer mean length of stay (25.5 vs 14.0 days; p= .002), an association that was confirmed on regression analysis (p < .001). Notably, no differences in mortality or graft failure at 1, 3, and 5 years were observed between older and younger LT recipients. Conclusion: LT recipients ≥ 70 years-old had positive post-transplant outcomes and similar patient and graft survival as patients < 70 years old, although older age was associated with a longer hospital stay. Overall, LT evaluation and eligibility age criteria may need to be reevaluated to be more age inclusive.

Volume

80

First Page

S974

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