Era-specific improvements in age-disparate outcomes after liver transplantation for acute liver failure: a population-based analysis of the United Kingdom and Ireland

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Transplantation

Abstract

Background: Emergency liver transplantation(LT)can be lifesaving in patients with acute liver failure(ALF),but waitlist and post-LT mortality may be high. Recipient age has been implicated as a key determinant of both, but how its effects have been impacted by recent improvements in post-LT outcomes is poorly characterized. In a large national cohort, we evaluated the impact of age on waitlist and post-LT outcomes and investigated how this has changed over time. Methods: We identified all patients listed for super urgent LT for ALF in the UK and Ireland from the NHSBT and the UK liver transplant registry between 1995-2021 and used Cox regression methods to assess the impact of age on waitlist and post-transplant mortality. Post-LT mortality hazard was assessed in early(0-3months)and late(3months-5years)follow-up epochs and across different eras of LT(1995-2009&2010-2021). Results: A total of 2,505 patients were listed for a super urgent LT for ALF, of whom 1,842 received an LT. Older patients had higher body mass index, fewer had renal, ventilatory, and inotropic support at listing, and were less likely to have paracetamol-induced liver failure. Donor characteristics were similar between age groups. There was no significant difference between the age groups in the adjusted cause-specific hazard of waitlist mortality. Stratified by the era of LT, there was no difference in the early(0-3months)post-LT mortality between recipients in the youngest and oldest groups. In the later post-transplant period(3months-5years),those in the older age groups had higher mortality, largely driven by poorer longerterm outcomes in the early era. Stratifying by age groups, the later era was associated with significantly lower overall post-LT mortality. Conclusions: For ALF patients, waitlist and short-term(0-3months) post-LT outcomes are similar across age groups. Era-specific improvements have occurred in long-term post-LT outcomes and have attenuated the disparate excess mortality hazard in older compared to the younger age groups.

Volume

107

Issue

9

First Page

19

Find It @ Sladen

Share

COinS