Haugen C, et al. - Researchers performed this study to assess trends in liver transplantation among older adults with end-stage liver disease. Over the past 10 years, despite a large increase in the number of older adults transplanted, a changing demographic of older liver transplant (LT) recipients, and a higher MELD, mortality and graft loss have decreased substantially for older LT recipients. They suggested considering these trends for LT referral and clinical decision-making in older adults.

Methods

• Using data from Scientific Registry of Transplant Recipients, researchers identified older (age ≥65) deceased donor liver-only recipients from January 1, 2003 to December 31, 2015.
• Temporal changes in recipient, donor, and LT characteristics were studied along with mortality and death-censored graft loss.
• An adjusted Cox proportional hazards calculate adjusted changes in outcomes were used over time.

Results

• Since 2003, researchers identified 7694 older adults who received LTs.
• Up from 9.1% (N=262) in 2003, older adults accounted for 19.0% of LT recipients in 2015 (N=1004).
• In 2015, older recipients were more frequently female, African-American, and had a higher BMI and MELD compared to older recipients in 2003.
• Also, in the indications for LT, there appeared a shift to a higher prevalence of hepatitis C, non-alcoholic fatty liver, and hepatocellular carcinoma.
• Between 2012 and 2015, mortality for older LT recipients was 44% lower (hazard ratio [HR]: 0.56, 95% CI: 0.49-0.64, p<0.001) than between 2003 to 2006.
• For older LT recipients, all cause graft loss between 2012-2015 was 43% lower (HR: 0.57, 95% CI: 0.50-0.66, p<0.001) than between 2003 to 2006