Trends and outcomes of liver transplantation among older recipients in the United States

Table 1 Baseline characteristics of the study population comparing age young group (age 18-64) vs older group (age ≥ 65 years)

	Young group, age 18-64 (n = 135758)	Older group, age ≥ 65 (n = 20000)	P value
Age (IQR)	52 (45-58)	67 (66-69)	< 0.001
Female, n (%)	47934 (35.3)	7612 (38.1)	< 0.001
Race, %			< 0.001
White	73.5	75.5
Black	8.9	6.0
Hispanic/Latino	12.5	12.1
Asian	3.8	5.4
Others	1.3	0.9
BMI (IQR)	27.4 (24.0-31.7)	27.7 (24.5-31.5)	0.571
HCV, %	44876 (33.1)	5236 (26.2)	< 0.001
Diabetes, n (%)	226584 (22.3)	6784 (35.7)	< 0.001
L1-MELD	18 (12-26)	15 (10-22)	< 0.001
R2-MELD	21 (14-30)	18 (12-26)	< 0.001
Primary disease, %
Alcohol cirrhosis	22.3	15.3	< 0.001
HCV cirrhosis	25.2	19.0	< 0.001
NASH	5.9	16.4	< 0.001
HCC	6.9	14.9	< 0.001
Acute liver failure	5.2	2.5	< 0.001
Acute alcoholic hepatitis	0.35	0.13	< 0.001
Previous surgery, n (%)	48407 (35.7)	8899 (44.5)	< 0.001
SBP, n (%)	9147 (6.7)	1084 (5.4)	< 0.001
TIPSS, n (%)	7231 (5.3)	1187 (5.9)	0.001
Portal vein thrombosis, n (%)	4875 (3.6)	1162 (5.8)	< 0.001
Mechanical ventilation, n (%)	10464 (7.6)	888 (4.3)	< 0.001
Dialysis, n (%)	14284 (10.5)	2059 (10.3)	0.167
Wait days, d (IQR)	82 (16-263)	118 (27-310)	< 0.001
Re-transplant, n (%)	10125 (7.5)	727 (3.6)	< 0.001

¹Listing.

²Most recent.

IQR: Interquartile; BMI: Body mass index; HCV: Hepatitis C virus; NASH: Non-alcohol steatohepatitis; HCC: Hepatocellular carcinoma; SBP: Spontaneous bacterial peritonitis; TIPSS: Trans-jugular intrahepatic portosystemic shunt; MELD: Model for end-stage liver disease.

Table 2 Donor characteristics and post-transplant outcomes

	Young, age 18-64 (n = 135758)	Older, age ≥ 65 (n = 20000)	P value
Donor age (IQR)	38 (24-52)	43 (28-56)	< 0.001
Donor female, n (%)	53967 (39.8)	8434 (42.2)	< 0.001
Donor race, %			< 0.001
White	70.3	68.2
Black	14.6	15.5
Hispanic/Latino	11.6	12.4
Asian	2.1	2.4
Others	1.4	1.6
Donor BMI (IQR)	25.6 (22.5-29.5)	26.2 (23.0-30.3)	< 0.001
Donor HCV, n (%)	4912 (3.6)	907 (4.5)	< 0.001
Cold ischemia time, h (IQR)	6.9 (5.0-9.0)	6.1 (4.8-8.0)	< 0.001
Donor risk index (IQR)	1.53 (1.35-1.81)	1.61 (1.38-1.94)	< 0.001
Outcomes
LOS, d (IQR)	11 (7-20)	10 (7-19)	0.261
Graft survival rate, (%)
1 yr	84.0	84.1	0.416
3 yr	77.0	77.1	0.206
5 yr	72.6	72.9	0.010
Overall survival rate
1 yr	88.6	86.5	< 0.001
3 yr	82.5	79.5	< 0.001
5 yr	78.3	75.1	< 0.001

IQR: Interquartile range; BMI: Body mass index; LOS: Post-transplant length of hospital stay; HCV: Hepatitis C virus.

Table 3 Multivariable cox regression for five-year graft survival

Variables	B (SE)	Hazard ratio (95%CI)	P value
Year of transplant	-0.04 (0.002)	0.958 (0.955-0.961)	< 0.001
Age ≥ 65	0.24 (0.02)	1.27 (1.22-1.32)	< 0.001
Male	0.10 (0.02)	1.11 (1.08-1.14)	< 0.001
BMI (per10)	-0.05 (0.01)	0.95 (0.93-0.98)	0.001
Race			0.001
Caucasian	Ref	1.0 (Ref)
African American	0.23 (0.02)	1.26 (1.21-1.31)	< 0.001
Hispanic	-0.11 (0.02)	0.90 (0.86-0.94)	< 0.001
Asian	-0.21 (0.04)	0.81 (0.75-0.87)	< 0.001
Pre-LT diabetes	0.20 (0.02)	1.22 (1.18-1.26)	< 0.001
Ventilation	0.51 (0.03)	1.67 (1.59-1.76)	< 0.001
Pre-LT dialysis	0.20 (0.02)	1.23 (1.17-1.28)	< 0.001
Retransplant	0.44 (0.03)	1.55 (1.47-1.63)	< 0.001
PVT	0.21 (0.03)	1.23 (1.16-1.31)	< 0.001
R1-MELD (per 10)	0.04 (0.01)	1.05 (1.03-1.06)	< 0.001
HCV recipient	0.28 (0.01)	1.33 (1.29-1.36)	< 0.001
Donor race			< 0.001
Caucasian	Ref	1.0 (Ref)
African American	0.06 (0.02)	1.06 (1.02-1.10)	0.001
Hispanic	0.10 (0.02)	1.11 (1.06-1.16)	< 0.001
Asian	0.19 (0.04)	1.21 (1.11-1.31)	< 0.001
Donor risk index	0.34 (0.03)	1.41 (1.34-1.48)	< 0.001
Cold ischemia time	0.014(0.002)	1.014 (1.010-1.019)	< 0.001

¹Most recent.

BMI: Body mass index; LT: Liver transplantation; PVT: Portal vein thrombosis; CI: Confidence interval; HCV: Hepatitis C virus; MELD: Model for end-stage liver disease.

Table 4 Multivariable cox regression for five-year graft survival in older group

Variables	B (SE)	Hazard ratio (95%CI)	P value
Year of transplant	-0.05 (0.004)	0.954 (0.947-0.961)	< 0.001
Male	0.19 (0.04)	1.21 (1.12-1.30)	< 0.001
Re-transplant	0.41 (0.08)	1.50 (1.28-1.76)	< 0.001
Pre-LT diabetes	0.17 (0.04)	1.18 (1.10-1.27)	< 0.001
Ventilation	0.42 (0.08)	1.52 (1.30-1.76)	< 0.001
Portal vein thrombosis	0.18 (0.07)	1.20 (1.05-1.36)	0.006
MELD (per 10)	0.13 (0.02)	1.14 (1.10-1.18)	< 0.001
HCV Recipient	0.21 (0.04)	1.23 (1.15-1.33)	< 0.001
Donor age (per 10)	0.03 (0.01)	1.03 (1.002-1.054)	0.032
Donor risk index	0.25 (0.06)	1.29 (1.15-1.44)	< 0.001
Cold ischemia time	0.017 (0.006)	1.02 (1.01-1.03)	0.003

LT: Liver transplantation; MELD: Model for end-stage liver disease; HCV: Hepatitis C virus; CI: Confidence interval.