Liver transplantation for elderly patients with early-stage hepatocellular carcinoma

Background Although liver resection is a viable option for patients with early-stage hepatocellular carcinoma (HCC), liver transplantation is the optimal treatment. The aim of this study was to identify characteristics of liver transplantation for elderly patients, and to assess the therapeutic benefit derived from liver transplantation over liver resection. Methods This was a population-based study of patients undergoing liver transplantation for HCC in the USA between 2004 and 2018. Data were retrieved from the National Cancer Database. Elderly patients were defined as individuals aged 70 years and over. Propensity score overlap weighting was used to control for heterogeneity between the liver resection and liver transplantation cohorts. Results Among 4909 liver transplant recipients, 215 patients (4.1 per cent) were classified as elderly. Among 5922 patients who underwent liver resection, 1907 (32.2 per cent) were elderly. Elderly patients who underwent liver transplantation did not have a higher hazard of dying during the first 5 years after transplantation than non-elderly recipients. After propensity score weighting, liver transplantation was associated with a lower risk of death than liver resection. Other factors associated with overall survival included diagnosis during 2016-2018, non-white/non-African American race, and & alpha;-fetoprotein level over 20 ng/dl. Conclusion Elderly patients with HCC should not be excluded from liver transplantation based on age only. Transplantation leads to favourable survival compared with liver resection. Although liver resection is a viable option, liver transplantation is the optimal treatment for patients with early-stage hepatocellular carcinoma. Data from the National Cancer Database demonstrated that liver transplantation was associated with a lower risk of death than liver resection (HR 0.55, 95 per cent c.i. 0.44 to 0.77; P < 0.001) among patients analysed using propensity score weighting.

Automated summary

This study aimed to identify characteristics of liver transplantation for elderly patients and assess the therapeutic benefit derived from liver transplantation over liver resection. The results showed that elderly patients who underwent liver transplantation had similar 5-year survival rates compared to non-elderly recipients. Liver transplantation was associated with a lower risk of death compared to liver resection.