Data(F Su et. al. Gastroenterol 2016; 150: 441-53) from 2002 thru 2014 indicate that liver transplant recipients are getting older.
The researchers reviewed data from the United Network for Organ Sharing (UNOS), including 60,820 adults who underwent liver transplantation and 122,606 listed for transplantation. Key findings:
- Mean age of those listed increased from 51.2 to 55.7 years. This trend was more prominent among those with hepatitis C (50.9 –>57.9).
- The proportion of listed patients ≥60 years increased from 19% to 41%.
- There were no differences in 5-year transplant-related survival “benefit”
The topic of survival “benefit” is reviewed in the discussion and the associated editorial (pg 306). The survival benefit is calculated as the difference between life expectancy with and without liver transplantation. So, even though older transplant recipients have worse post-transplantation survival, this is counterbalance by the increased risk of waitlist mortality. It is quite likely, however, that with more time (>5 year followup) that the survival benefit for younger patients would be more apparent. In addition, the idea that the survival benefit could be equivalent could be influenced by selection bias. Many transplant centers may be more selective when deciding to place older patients (>70 years) on the waitlist.
My take: The steady increase in age in adult liver transplant recipients is a concern due to worse outcomes in older patients. This trend could be reversed if hepatitis C becomes a less frequent indication for liver transplantation.
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