HPB : the official journal of the International Hepato Pancreato Biliary Association · 2021
The impact of advanced patient age in liver transplantation: a European Liver Transplant Registry propensity-score matching study.
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Gómez-Gavara Concepción, Lim Chetana, Adam René, Zieniewicz Krzysztof, Karam Vincent, Mirza Darius, Heneghan Michael, Pirenne Jacques, Cherqui Daniel, Oniscu Gabriel, Watson Christopher, Schneeberger Stefan, Boudjema Karim, Fondevila Constantino, Pratschke Johann, Salloum Chady, Esposito Francesco, Esono Daniel, Lahat Eylon, Feray Cyrille, Azoulay Daniel, all the ELTR centers (www.eltr.org) for the European Liver and Intestine Transplant Association (ELITA)
Аннотация
BACKGROUND: The futility of liver transplantation in elderly recipients remains under debate in the HCV eradication era.
METHODS: The aim was to assess the effect of older age on outcome after liver transplantation. We used the ELTR to study the relationship between recipient age and post-transplant outcome. Young and elderly recipients were compared using a PSM method.
RESULTS: A total of 10,172 cases were analysed. Recipient age >65 years was identified as an independent risk factor associated with reduced patient survival (HR:1.42 95%CI:1.23-1.65,p < 0.001). After PSM, 2124 patients were matched, and the same association was found between elderly recipients and patient survival and graft survival (p < 0.001). As hepatocellular carcinoma and alcoholic cirrhosis were independent prognostic factors for patient and graft survival a propensity score-matching was performed for each. Patient and graft survival were significantly worse (p < 0.05) in the alcoholic cirrhosis elderly group. However, patient and graft survival in the hepatocellular carcinoma cohort were similar (p > 0.05) between groups.
CONCLUSION: Liver transplantation is an acceptable and safe curative option for elderly transplant candidates, with worse long-term outcomes compare to young candidates. The underlying liver disease for liver transplantation has a significant impact on the selection of elderly patients.
METHODS: The aim was to assess the effect of older age on outcome after liver transplantation. We used the ELTR to study the relationship between recipient age and post-transplant outcome. Young and elderly recipients were compared using a PSM method.
RESULTS: A total of 10,172 cases were analysed. Recipient age >65 years was identified as an independent risk factor associated with reduced patient survival (HR:1.42 95%CI:1.23-1.65,p < 0.001). After PSM, 2124 patients were matched, and the same association was found between elderly recipients and patient survival and graft survival (p < 0.001). As hepatocellular carcinoma and alcoholic cirrhosis were independent prognostic factors for patient and graft survival a propensity score-matching was performed for each. Patient and graft survival were significantly worse (p < 0.05) in the alcoholic cirrhosis elderly group. However, patient and graft survival in the hepatocellular carcinoma cohort were similar (p > 0.05) between groups.
CONCLUSION: Liver transplantation is an acceptable and safe curative option for elderly transplant candidates, with worse long-term outcomes compare to young candidates. The underlying liver disease for liver transplantation has a significant impact on the selection of elderly patients.