Liver transplant: age alone should not be a barrier, study suggests

  • Haugen CE & al.
  • J Am Geriatr Soc
  • 16 Oct 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Liver transplant (LT) rates have increased dramatically among older adults (age ≥65 years) over the last 14 years, accompanied by improvements in length of stay (LOS), acute rejection, graft survival, and recipient survival.

Why this matters

  • Older age alone should not limit access to LT among adults with end-stage liver disease.

Study design

  • Prospective US national cohort study of 8627 adults aged ≥65 years undergoing LT during 2003-2016, from the Scientific Registry of Transplant Recipients.
  • Funding: National Institute of Diabetes and Digestive and Kidney Disease, National Institute on Aging.

Key results

  • LTs performed in older adults nearly quintupled from 263 in 2003 to 1144 in 2016, representing a rise from 9.5% to 20.7% of the LT population.
  • Elderly recipients in 2013-2016 vs 2003-2016 more likely to be male (P=.006) and black (P<.001 with for end-stage liver disease score vs p and portal vein thrombosis undergoing lt nonalcoholic steatohepatitis or hepatocellular carcinoma>
  • Over the 14-year span,  
    • Inpatient stay shortened (LOS >2 weeks, aOR=0.66; P<.001>
    • 1-year acute rejection rates dropped (aOR=0.70; P=.002).
    • All-cause graft loss decreased (aOR=0.46; P<.001>
    • Mortality decreased (aHR=0.43; P<.001>

Limitations

  • Comorbidity data not captured.

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