The impact of advanced patient age in liver transplantation: a European Liver Transplant Registry propensity-score matching study |
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| Institution: | 1. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Vall D´Hebrón Hospital, Barcelona, Spain;2. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Paris, France;3. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France;4. Department of General and Liver Surgery, Medical University of Warsaw, Banacha, Poland;5. HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK;6. Institute of Liver Studies, King''s College Hospital, London, UK;7. Abdominal Transplant Surgery, Transplantation Research Group, KU, Leuven, Belgium;8. Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Edinburgh, United Kingdom;9. Department of Surgery, Addenbrooke´s Hospital, Cambridge, United Kingdom;10. Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;11. Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France;12. General & Digestive Surgery, Institut Clínic de Malalties Digestives I Metabòliques, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain;13. Department of Surgery, Campus Mitte/Campus Virchow, Charité University Hospital, Berlin, Germany;14. Department of Digestive Surgery, Grand Hôpital de L''Est Francilien, Meaux, France;15. Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain;16. Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Israel;1. Excellence Center for Gastrointestinal Endoscopy and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society;2. Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University;3. Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University;4. Tropical Medicine Cluster, Chulalongkorn University;5. Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;6. Department of Surgery, Section of Surgical Endoscopy and Minimally Invasive Surgery, Rizal Medical Center, Philippines;7. Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;1. Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland;2. University of Basel, Faculty of Medicine, Klingelbergstrasse 61, 4056, Basel, Switzerland;3. Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland;4. Institute of Radiology, University Hospital Basel, Petersgraben 4, 4051, Basel, Switzerland;5. Institute of Radiology, St. Clara Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland;1. Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands;2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;3. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;4. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;5. Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands;1. Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, MA, USA;2. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;3. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA;1. Oregon Heath & Science University (OHSU), Department of Surgery, Portland, OR 97239, USA;2. Yale School of Medicine, Department of Surgery, New Haven, CT 06510, USA;3. OHSU, Department of Pathology, Knight Cancer Institute, Portland, OR 97239, USA;4. Portland VA Health Care System and OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, OR 97239, USA;5. OHSU Department of Surgery, Division of Surgical Oncology, Knight Cancer Institute, Portland, OR 97239, USA |
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| Abstract: | BackgroundThe futility of liver transplantation in elderly recipients remains under debate in the HCV eradication era.MethodsThe 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.ResultsA 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.ConclusionLiver 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. |
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