Evaluating Post-Transplant Outcomes in Elderly Liver Recipients: A Comparative Study of Patients Aged Over 70

Abstract

Background

The increasing average age of the population has led to a higher percentage of elderly patients awaiting liver transplantation (LT). However, advanced age has been considered an independent risk factor for candidates. This study aims to evaluate post-transplant outcomes in patients over 70 years, traditionally viewed as an age limit for LT.

Methods

We performed a prospective analysis of 584 liver transplant recipients at our center between January 2018 to November 2023, dividing them into two groups: under 70 years (n=548) and over 70 years (n=36). Categorical variables were reported as numbers and percentages, while continuous variables were expressed as medians and interquartile ranges (IQR). The two groups differed significantly only in MELD and cirrhosis etiology. To reduce selection bias, we performed propensity score matching (PSM) at a 3:1 ratio, without replacement, based on MELD and cirrhosis etiology.

Results

The median age was 58 years (IQR 52-63) in the younger group and 71 years (IQR 70-72) for the older group (p<0.001). Viral cirrhosis was more frequent in younger group patients (36.1% vs 13.1 %), while MASLD was more common in those over 70 (13.1% vs 25 %) (p=0.013). The MELD scores were lower in patients over 70 (13, IQR 9-17) compared to the young group (15, IQR 10-23) (p=0.032). Both groups were homogeneous in sex and BMI (p>0.05). No significant differences were observed in cirrhosis-related complications (ascites, encephalopathy, portal hypertension, jaundice, coagulopathy, varices, hepatocellular carcinoma; p>0.05) or donor characteristics. Postoperative complications, including early allograft dysfunction, hepatic artery thrombosis, and biliary or cardiological complications, were also similar (p>0.05). The Comprehensive Complication Index was comparable (30.2, IQR 20.9–48.3 in <70 vs. 29.6, IQR 21–38.35 in ≥70; p=0.519), as was the 90-day readmission rate (p>0.05). After PSM, MELD scores and cirrhosis etiology were balanced between groups. No significant differences were shown in preoperative, donor, and postoperative characteristics.

Conclusions

With careful selection, patients over 70 years of age can achieve post-liver transplant outcomes comparable to younger patients. These findings suggest that advanced age alone should not be considered an absolute contraindication. Instead, a comprehensive, multidimensional assessment is essential to identify suitable candidates.