Is liver transplantation safe and effective in elderly (≥70 years) recipients? A case-controlled analysis

BackgroundElderly patients are evaluated for liver transplantation (LT) with increasing frequency, but outcomes in this group have not been well defined. MethodsA linkage of the Scientific Registry of Transplant Recipients (SRTR) and the University HealthSystem Consortium (UHC) databases identified 12445 patients who underwent LT during 2007-2011. Two cohorts were created consisting of, respectively, elderly recipients aged 70 years (n = 323) and recipients aged 18-69 years (n = 12122). A 1:1 case-matched analysis was performed based on propensity scores. ResultsElderly recipients had lower Model for End-stage Liver Disease (MELD) scores at LT (median 15 versus 19; P < 0.0001), more often underwent transplantation at high-volume centres (46% versus 33%; P < 0.0001) and more often received grafts from donors aged >60 years (24% versus 15%; P < 0.0001). The two cohorts had similar hospital lengths of stay, in-hospital mortality, hospital costs and 30-day readmission rates. There were no differences in graft survival between the two cohorts (P = 0.10), but elderly recipients had worse longterm overall survival (P = 0.009). However, a case-controlled analysis confirmed similar perioperative hospital outcomes, graft survival and longterm patient survival in the two matched cohorts. ConclusionsElderly LT recipients accounted for <3% of all LTs performed during 2007-2011. Selected elderly recipients have perioperative outcomes and survival similar to those in younger adults.