Evaluation of Liver Transplantation Among Advanced Age Recipients in a Large Multicenter U. S. Cohort
Goel A, Kwong A, Devuni D, Wang C, Boike J, Jo J, Van Wagner L, Serper M, Jones L, Sharma R, Vema E, Shor J, German M, Hristov A, Lee A, Slengler E, Koteish A, Sehmbey G, Seetharam A, John N, Patel Y, Kappus M, Couri T, Salgia R, Nhu Q, Frenette C, and Lai J. Evaluation of Liver Transplantation Among Advanced Age Recipients in a Large Multicenter U. S. Cohort. Am J Transplant 2019; 19:718.
Am J Transplant
Purpose: The proportion of adults >70 years (y) listed for liver transplant (LT) in the U. S. is rising. Outcomes in this growing population are limited to small, single-center cohorts or national database studies that lack granularity. We aimed to better characterize outcomes in LT recipients >70y in a large multicenter cohort. Methods: All primaty LT recipients (LTR) >65y~who underwent LT from 2010-16 at 13 centers were included. For LTRs >70y, survival was estimated using Kaplan-Meier methods; other outcomes were assessed within ly post-LT and compared toLTRs<70y. Results: Of 179 LTRs >70y, median was age 71y (range 70-78), 64% were male. and 770/c Caucasian. Leading indications for LT were NASH (27%), alcohol (11%). HCV (17%). 52% had HCC, of which 63% had MELD exceptions. Median laboratory MELDNa at LT was 19 (IQR 13-26), and median allocation MELD was 22 (IQR16-29). Comorbidities included diabetes (39%), congestive heart failure (8%), cerebrovascular disease (6%), chronic pulmonaty disease (11%), renal disease (38%). and osteoporosis/osteopenia (42%). The median donor age was 48y (33-62); 8% were donations after cardiac death, 10% living donation LT, and 6% SLK During LT, 1. 70/0 received induction with a T-cell depleting agent compared to 9% of LTRs <70y in the cohort. At discharge, 77% were on calcineurin inhibitors and 73% on steroids vs 85% and 84% respectively, of LTRs <70y. Within ly post-LT, graft rejection occurred in 18% and biliary strictures in 26%. Cardiovascular complications occurred in 25% (12% afib, 3% MI, 8% stroke and 9% heart failure), delirium in 16% and seizures in 3%. Viral, bacterial and fungal infections occurred ly post-LT in 17% 39% and 7% respectively. Solid organ cancers ly post-LT occurred in 10% with recurrent HCC (40/0) and lung cancer (2%) being the most common; this is compared to 4% in the cohort <70y (p=0. 002). One-year and three-year patient survival was 89% and 76% respectively, vs 90% and 84% in <70y. Conclusions: In a large US multicenter cohort, ly and 3y survival in LTRs >70y were acceptable. De novo solid organ cancers within ly post-LT occurred in 10% of LTRs >70y, more frequently than in those <70y. Our data provide further understanding of the comorbidities experienced in advanced age LTRs and lay the foundation for improved selection and management of older LTRs.