Outcome of liver transplantion in recipients older than 65 years: A single center experience

Abstract

Advanced age was considered a relative contraindication for liver transplantation (LT) in the past. The percentage of older patients referred for LT assessment has markedly increased in almost all LT centers over the last years. The data regarding the outcome of older patients have been contradictory. Therefore, we aimed to evaluate the long-term survival of LT recipients older than 65 years. Between 1982 and 2008, 106 out of 1011 patients (10.5%), who underwent LT at our institution, were older than 65 years. Almost all of these patients were transplanted after 1995. The mean age was 67.5 (65.0–76.4) years and the majority of patients were male (76%). Regarding underlying liver disease the percentage of non-alcoholic steatohepatitis associated cirrhosis was significantly higher in the older age group (15.9% vs. 5.8%, p<0.01) compared to the younger LT cohort. In contrast, alcoholic liver disease was more common in recipients under 65 years (20.4% vs. 14.1%, p<0.01). Significantly more patients in the older group presented with a concomitant hepatocellular carcinoma (40.6% vs. 23.7%, p<0.01). Both groups did not differ with regard to Child-Pugh classification and mean MELD score. The median follow-up of the older patients was 3.2 compared to 5.7 years of the younger cohort. The actuarial patient survival rates at 1-, 5- and 10-years with 85%, 65% and 56% were slightly lower in the older recipients compared to 87%, 75% and 66% of recipients ≤65 years. The major causes of death in the elderly were sepsis (n=13) in the early postoperative period and de-novo cancer (n=6), HCV/HCC recurrence (each n=5) and cardiovascular complications (n=4) in the late one. The incidence of de-novo cancers and cardiovascular diseases were significantly higher in the older age cohort. The percentage of reLTs did not differ between both groups (7.8% vs. 6.5%). Although overall survival was better for younger patients, this study shows that LT recipients older than 65 years have a favourable outcome after LT with a 5- and 10-year survival of 65% and 56%, indicating that liver transplantation should be considered in patients older than 65 years.