S1184 Factors Associated With Futility of Liver Transplant in Elderly Recipients: A Single Center Experience

Abstract

INTRODUCTION: As the population of the United States ages, there has been an increasing number of elderly patients with cirrhosis listed for transplant. Previous studies have shown variable results in terms of the relative survival benefit for elderly liver transplant recipients. We sought to identify factors associated with futility of transplant in elderly patients, as well as with mortality at one year to help guide allocation of a precious resource. METHODS: The patient population included all patients above the age of 65 who underwent liver transplantation at our center between January 2012 and March 2020. Futile outcome was defined as death within 90 days of transplant. Statistical analysis was performed to determine what variables, if any were associated with futile outcome and with one year mortality in this population. Demographic data (see Table 1) are presented as number and percentage and compared using Chi square test or Fischer’s exact test. Continuous variables are presented as mean ± SD and compared using Mann-Whittney U-test or independent sample t-test. RESULTS: There were a total of 260 patients aged 65 years or older who received LT in the designated time period. A total of 20 patients met the definition of “futile” outcome. The mean MELD in the “futile” group was 21.78 and 19.66 in the “non-futile” group (P = 0.236). Of the variables tested, only congestive heart failure was found to have a statistically significant association with futile outcome in LT recipients over the age of 65 (P = 0.001). Of these patients, all had diastolic heart failure with normal ejection fraction and at least grade I diastolic dysfunction as measured on echocardiogram. The outcome of death within one year of transplant had a statistically significant association with alpha-1 antitrypsin deficiency (P = 0.039) and pulmonary hypertension (P = 0.011). CONCLUSION: Diastolic congestive heart failure in the elderly may be a predictor for futility of liver transplant in recipients aged 65 years and older. Diastolic dysfunction seen on echocardiogram may be an objective measurement that can be used to risk stratify elderly patients. In addition, alpha-1 antitrypsin deficiency and pulmonary hypertension may be prognostic indicators for one year mortality after liver transplant in the elderly.Table 1.: Comparison of characteristics of patients over the age of 65 who underwent transplant and died within 90 days from transplant compared to those who survived beyond 90 days