Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: The proportion of adults ≥70 years (y) listed for liver transplant (LT) in the U.S. is rising. Outcomes in this growing population are limited to small, single-center cohorts or national database studies that lack granularity. We aimed to better characterize outcomes in LT recipients ≥70y in a large multicenter cohort.
*Methods: All primary LT recipients (LTR) >65y who underwent LT from 2010-16 at 13 centers were included. For LTRs >70y, survival was estimated using Kaplan-Meier methods; other outcomes were assessed within 1y post-LT and compared to LTRs <70y.
*Results: Of 179 LTRs >70y, median was age 71y (range 70-78), 64% were male, and 77% Caucasian. Leading indications for LT were NASH (27%), alcohol (17%), HCV (17%). 52% had HCC, of which 63% had MELD exceptions. Median laboratory MELDNa at LT was 19 (IQR 13-26), and median allocation MELD was 22 (IQR 16-29). Comorbidities included diabetes (39%), congestive heart failure (8%), cerebrovascular disease (6%), chronic pulmonary disease (11%), renal disease (38%), and osteoporosis/osteopenia (42%). The median donor age was 48y (33-62); 8% were donations after cardiac death, 10% living donation LT, and 6% SLK. During LT, 1.7% received induction with a T-cell depleting agent compared to 9% of LTRs <70y in the cohort. At discharge, 77% were on calcineurin inhibitors and 73% on steroids vs 85% and 84%, respectively, of LTRs <70y. Within 1y post-LT, graft rejection occurred in 18% and biliary strictures in 26%. Cardiovascular complications occurred in 25% (12% afib, 3% MI, 8% stroke and 9% heart failure), delirium in 16%, and seizures in 3%. Viral, bacterial and fungal infections occurred 1y post-LT in 17%, 39% and 7%, respectively. Solid organ cancers 1y post-LT occurred in 10% with recurrent HCC (4%) and lung cancer (2%) being the most common; this is compared to 4% in the cohort <70y (p=0.002). One-year and three-year patient survival was 89% and 76%, respectively, vs 90% and 84% in <70y.
*Conclusions: In a large US multicenter cohort, 1y and 3y survival in LTRs ≥70y were acceptable. De novo solid organ cancers within 1y post-LT occurred in 10% of LTRs ≥70y, more frequently than in those <70y. Our data provide further understanding of the comorbidities experienced in advanced age LTRs and lay the foundation for improved selection and management of older LTRs.
To cite this abstract in AMA style:Goel A, Kwong A, Devuni D, Wang C, Boike J, Jo J, VanWagner L, Serper M, Jones L, Sharma R, Verna E, Shor J, German M, Hristov A, Lee A, Spengler E, Koteish A, Sehmbey G, Seetharam A, John N, Patel Y, Kappus M, Couri T, Salgia R, Nhu Q, Frenette C, Lai J. Evaluation of Liver Transplantation among Advanced Age Recipients in a Large Multicenter U.S. Cohort [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-liver-transplantation-among-advanced-age-recipients-in-a-large-multicenter-u-s-cohort/. Accessed April 15, 2021.
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