As the population ages and as the average age of liver transplant (LT) waitlist candidates increases, understanding of the trends and outcomes is imperative for clinical decision-making, appropriate referral for LT and post-LT care in older adults.

METHODS

Older (age>=65) deceased donor liver-only recipients were identified using data from SRTR from 1/1/2003- 12/31/2015. We studied temporal changes in recipient, donor and LT characteristics along with mortality and death-censored graft loss. We used an adjusted Cox proportional hazards calculate adjusted changes in outcomes over time.

RESULTS

Since 2003, 7,694 older adults have received LTs. Older adults accounted for 19.0% of LT recipients in 2015 (N=1004), up from 9.1% (N=262) in 2003. Older recipients in 2015 were more likely to be female, African-American, and have a higher BMI and MELD compared to older recipients in 2003. Also, the indications for LT shifted to a higher prevalence of hepatitis C, non-alcoholic fatty liver, and hepatocellular carcinoma. Mortality for older LT recipients between 2012-2015 was 44% lower (HR: 0.56, 95%CI: 0.49-0.64, p<0.001) than between 2003-2006. All cause graft loss for older LT recipients between 2012-2015 was 43% lower (HR: 0.57, 95%CI: 0.50-0.66, p<0.001) than between 2003-2006. CONCLUSIONS

Despite a large increase in the number of older adults transplanted, a changing demographic of older LT recipients, and a higher MELD, mortality and graft loss have decreased substantially for older LT recipients over the past 10 years. These trends are important for consideration for LT referral and clinical decision-making in older adults.

CITATION INFORMATION: Haugen C, Huang Q, Pozo M, McAdams-DeMarco M, Segev D. Trends in Liver Transplantation Among Older Adults with ESLD. Am J Transplant. 2017;17 (suppl 3).

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