Retrospective Study of Liver Transplant Recipients Over 69: Clinical Features and Outcomes of a Growing Group

Background

The introduction of direct-acting antivirals for hepatitis C virus has shifted liver transplantation (LT) demographics, with patients receiving increasingly more LT for other chronic liver diseases and at older ages. Historically, younger patients have been prioritized for LT due to concerns about post-transplant outcomes in older patients; however, emerging evidence suggests a need to reassess age-based eligibility criteria. This study describes the clinical characteristics and postoperative LT outcomes of patients ≥70 years compared to patients < 70 years old.

Methods

Single center retrospective chart review of all patients who underwent LT at an academic transplant center between January 1, 2014, and September 26, 2023.

Results

Of 999 LT recipients, 43 were ≥70 years old (median 71 y; range 70-75) and 956 were <70 years old (median 58 y; range 16-69). Postoperative liver function laboratory values, biliary complication rates, need for further procedures, and hospital readmission were similar between groups. The older cohort had a significantly longer mean length of stay (25.5 vs 14.0 days; P = .002), an association that was confirmed on regression analysis (P < .001). Notably, no differences in mortality or graft failure at 1, 3, and 5 years were observed between older and younger LT recipients.

Conclusions

LT recipients ≥70 years-old had positive post-transplant outcomes and similar patient and graft survival as patients <70 years old, although older age was associated with a longer hospital stay. Overall, LT evaluation and eligibility age criteria may need to be reevaluated to be more age inclusive.