Since 2002, MELD score has been the basis of liver allocation system. Among older adult liver transplant (LT) recipients, short-term outcomes in MELD era were comparable to the pre-MELD era, but few studies have assessed long-term outcomes.

This is a registry study of UNOS database including patients age ≥50 who underwent LT from February 27, 2002 until October 31, 2011. Patients were characterized into age groups: 50-54, 55-59, 60-64, 65-69 and ≥70. Pre-transplant and 6-month post-transplant patient functional status (PFS) were evaluated as good, moderate and poor based on activity of daily living performance or Karnofsky score. Time to death and graft failure (GF) over 5-years was modeled using Cox regression to test for differences in age groups (50-54 as reference) with covariates of donor age, pre-transplant PFS, pre-transplant dialysis, MELD score and combined transplantation. PFS improvement at 6-month post-transplant was evaluated using logistic regression model adjusted for same covariates.

A total of 38,222 LT recipients met inclusion criteria. With increasing age, there were more female recipients, fewer black recipients, fewer alcohol-related liver disease, more recipients with MELD <20, more recipients with hypertension and malignancy, more donors age ≥60 and less acute rejections within 6 months. All comparisons had p < 0.001. 23,762 recipients had pre-transplant PFS. Recipients with MELD ≥20 (OR=1.37, 95% CI 1.24-1.51) and pre-transplant dialysis (OR=1.36, 95% C.I. 1.04-1.78) have significant PFS improvement at 6 months post-transplant. Over-all mortality and GF were 24.2% and 11.3%, respectively. Higher 5-year mortality was observed in age groups ≥60 (p <0.001). However, lower 5-year GF was observed in age groups 60-64 and 65-69 year old (p <0.001). Donor age ≥60, MELD ≥20, and poor or moderate pre-transplant PFS were significantly associated with greater 5-year mortality and GF. However, pre-transplant dialysis significantly had higher risk of death but not GF, while combined transplantation significantly had lower risk of GF but not death.

In conclusion, 5-year mortality was greater among adults ≥60 years after LT. Impaired pre-transplant PFS was associated with 5-year mortality and GF. The likelihood of PFS improvement was found for on dialysis and MELD ≥20. Prior to LT of older adults, functional status evaluation can assist in identifying those at risk for adverse outcomes.

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