Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.259
Peer-review started: January 16, 2022
First decision: March 16, 2022
Revised: March 30, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 18, 2022
Processing time: 213 Days and 7.8 Hours
The average age of liver transplant and the number of liver transplant in the older recipients is increasing.
We wanted to investigate the outcomes of expansion of criteria of liver transplantation (LT) with increasing inclusion of older recipients and donors. We also wanted to identify any potentially modifiable risk factors that may be associated lower with graft or patient survival.
We compared one, three- and five-year graft and patient survival between two groups of liver transplant recipients: Younger group (18-64 years old) and older group (≥ 65 years old) between the period of 1987-2019 in the United States.
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).
The number of LT for older patients was highest in 2019 (1920). In the older group, the percentage of non-alcoholic steatohepatitis and hepatocellular carcinoma as the primary etiology for LT was higher than younger group compared to the older group (16.4 % vs 5.9%; 14.9% vs 6.9%). On univariable analysis, there was no difference in post-transplant length of hospitalization, one-year and five-year overall survivals between the two groups. On multivariable Cox-Hazard regression analysis for graft survival, older group (hazard ratio: 1.27, P < 0.001) had higher risk of graft failure which was associated with male gender, pre-transplant diabetes, previous history of LT, ventilation at the time of LT, high model for end-stage liver disease score, recipient portal vein thrombosis, hepatitis C virus positive status, and higher donor risk index.
Older age alone should not be considered to be a contraindication for LT.
Careful evaluation process and postoperative care are necessary to improve transplant outcomes.