Factors predicting futility of liver transplant in elderly recipients: A single-center experience

Table 1 Comparison of patients over the age of 65 who underwent transplant and died within 90 d from transplant compared to those who survived beyond 90 d

Characteristic	Death within 90 d, N = 20	Survival beyond 90 d, N = 240	P value
Age, mean ± SD	67.30 ± 1.78	67.81 ± 2.71	0.821
Year of transplant, median (percentiles)	2014 (2012-2016)	2015 (2013-2018)	0.183
Comorbid conditions, n (%)
Obesity	6 (30.0)	57 (23.8)	0.590
CHF	6 (30.0)	12 (5.0)	0.001a
CKD	1 (5.0)	23 (9.6)	0.705
HTN	14 (70.0)	152 (63.3)	0.550
DM	9 (45.0)	109 (45.4)	0.971
CAD	8 (40.0)	73 (30.4)	0.374
PH	2 (10.0)	9 (3.8)	0.203
Arrhythmias	3 (15.0)	32 (13.3)	0.739
Pre-transplant severity of disease
Ascites
None	2 (10.0)	34 (14.2)	0.269
Mild	7 (35.0)	111 (46.3)
Moderate	3 (15.0)	45 (18.8)
Severe	8 (40.0)	50 (20.8)
Encephalopathy
None	3 (15.0)	61 (25.4)	0.397
Grade 1-2	17 (85.0)	172 (71.7)
Grade 3-4	0 (0)	7 (2.9)
Child-Pugh Score	9.8 +/- 1.7	9.08 +/- 2.0	0.127
A	0 (0)	26 (10.5)	0.257
B	8 (40)	116 (48.3)
C	12 (60.0)	98 (40.8)
Karnofsky performance index	53.50 ± 20.1	55.69 ± 21.6	0.555
Indication for transplant, n (%)
Cirrhosis	16 (80.0)	147 (56.5)	0.143
NASH	6 (30.0)	54 (22.5)	0.419
Autoimmune	2 (10.0)	3 (1.3)	0.049
Alcohol	2 (10.0)	32 (13.3)	0.999
Hepatitis C	2 (10.0)	18 (7.5)	0.658
Cryptogenic	1 (5.0)	14 (5.8)	0.999
PSC	0 (0)	11 (4.6)	0.999
PBC	2 (10.0)	11 (4.6)	0.263
Hemochromatosis	0 (0)	4 (1.7)	0.999
HCC and cirrhosis	4 (20.0)	87 (36.3)	0.143
Acute liver failure	0 (0)	6 (2.5)	0.999
Primary etiology of liver disease, n (%)
Alcohol related cirrhosis	2 (10)	46 (19.2)	0.55
NASH cirrhosis	8 (40)	78 (32.5)	0.49
Cirrhosis due to viral hepatitis	2 (10)	48 (20)	0.38
Other	8 (40)	68 (28.3)	0.27
Lab values, mean ± SD
Sodium	135.70 ± 4.3	136.12 ± 4.3	0.678
INR	1.51 ± 0.4	1.49 ± 0.5	0.241
Creatinine	1.68 ± 1.0	1.45 ± 1.0	0.133
Total Bili	6.34 ± 6.8	5.46 ± 7.8	0.271
MELD-Sodium	21.78 ± 8.6	19.66 ± 9.0	0.236
Albumin	3.16 ± 0.6	3.18 ± 0.6	0.889

^aP < 0.05. CHF: Congestive heart failure; CKD: Chronic kidney disease; HTN: Hypertension; DM: Diabetes mellitus; CAD: Coronary artery disease; PH: Pulmonary hypertension; NASH: Non-alcoholic steatohepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cholangitis; HCC: Hepatocellular carcinoma; INR: International normalized ratio; MELD: Model of End-Stage Liver Disease.

Table 2 Binary Logistic Regression analysis to calculate adjusted odds ratio for death within 90 d of transplant

Variable	Adjusted OR	Confidence interval	P value
MELD-Na	1.02	0.95-1.09	0.615
Age at transplant	1.09	0.89-1.32	0.421
CPS-C vs CPS A and B	3.25	0.86-12.25	0.081
CHF	9.44	2.89-30.81	< 0.0001

OR: Odds ratio; MELD: Model of End-Stage Liver Disease; CPS: Child-Pugh Score; CHF: Congestive heart failure.

Table 3 Outcomes analysis for different age groups

Age category	45-54 years	55-64 years	≥ 65 years	P value
30-d mortality (n, %)	8 (3.0)	12 (2.4)	10 (3.8)	0.55
1-yr mortality (n, %)	32 (12.0)	75 (15.2)	59 (22.7)	0.03
ICU LOS
mean ± SD	3.80 ± 6.8	3.99 ± 6.8	4.17 ± 6.6	0.320
Median (IQR)	2.0 (1.0-3.0)	2.0 (1.0-4.0)	2.0 (1.0-4.0)
Total hospitalization
mean ± SD	13.22 ± 15.4	14.14 ± 24.0	16.8 ± 23.9	0.034
Median (IQR)	10.0 (7.0-14.0)	10.0 (7.0-15.0)	11.0 (8.0-17.0)
Discharge disposition (n = 890) (n, %)
Home	182 (76.2)	314 (73.4)	133 (59.6)	0.000
Home or HHC	190 (79.5)	329 (76.9)	142 (63.7)	0.000
Any facility other than home [excluding patients who died during hospitalization, n = 854)]	42 (18.1)	84 (20.3)	67 (32.1)	0.001
Acute Rehab	13 (5.4)	7 (4.0)	9 (4.0)
LTAC	9 (3.8)	21 (4.9)	13 (5.8)
SNF	20 (8.4)	45 (10.5)	45 (20.2)
Deceased	7 (2.9)	15 (3.5)	14 (6.3)
Hospice	0	1 (0.2)	0

ICU: Intensive care unit; LOS: Length of stay; IQR: Interquartile range; HHC: Hand hygiene compliance; LTAC: Long-term acute care hospital; SNF: Skilled nursing facility.

Table 4 Cox Regression Survival Analysis for comparison between different age groups for 1-year mortality

Factor	Hazard ratio	P value	95%CI
			Lower	Upper
MELD-Na	1.011	0.174	0.995	1.028
CHF	1.425	0.210	0.819	2.480
Obesity	0.907	0.618	0.617	1.333
Hypertension	0.967	0.839	0.697	1.341
Type 2 diabetes	1.210	0.252	0.873	1.678
Coronary artery disease	1.054	0.781	0.726	1.532
Age 55-64 vs Age < 55	1.252	0.293	0.824	1.902
Pulmonary hypertension	1.209	0.539	0.660	2.217
Age > 65 vs Age <65	1.937	.003	1.244	3.017

MELD: Model of End-Stage Liver Disease; CHF: Congestive heart failure.