Aging of Liver Transplant Registrants and Recipients: Trends and Impact on Waitlist Outcomes, Post-Transplantation Outcomes, and Transplant-Related Survival Benefit

Su, Feng; Lei, Yu; Berry, Kristin; Liou, Iris; Landis, Charles; Rayhill, Stephen C.; Reyes, Jorgé; Ioannou, George N.

doi:10.1053/j.gastro.2015.10.043

Cited by 166 publications

(211 citation statements)

References 37 publications

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“…Waitlist mortality increased with age, independent of the severity of liver disease, consistent with previous studies [10, 11]. The causes of death on the waitlist were not thoroughly reported, and it is difficult to discern whether there were differences in liver-related and non-liver-related mortalities.…”

Section: Discussionsupporting

confidence: 85%

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

et al. 2017

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Background There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized. Aims To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC. Methods The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18–39 (young), 40–59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared. Results Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p <0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p <0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p <0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001). Conclusions Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings.

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Section: Discussionsupporting

confidence: 85%

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

et al. 2017

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“…The changing etiology of ESLD may impact the utility of listing patients for LT as older patients with multiple comorbidities may be more likely to die or be removed from the wait list than receive a transplant. (3, 4)…”

Section: Introductionmentioning

confidence: 99%

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Mayorga

Orman

et al. 2017

Transplantation

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Background Changes in the epidemiology of end stage liver disease may lead to increased risk of dropout from the liver transplant waitlist. Anticipating the future of liver transplant waitlist characteristics is vital when considering organ allocation policy. Methods We performed a discrete event simulation to forecast patient characteristics and rate of waitlist dropout. Estimates were simulated from 2015–2025. The model was informed by data from the Organ Procurement and Transplant Network, 2003–2014. National data are estimated along with forecasts for 2 regions. Results NASH will increase from 18% of waitlist additions to 22% by 2025. Hepatitis C will fall from 30% to 21%. Listings over age 60 will increase from 36% to 48%. The hazard of dropout will increase from 41% to 46% nationally. Wait times for transplant for patients listed with a MELD between 22 and 27 will double. Region 5, which transplants at relatively higher MELD scores, will experience an increase from 53% to 64% waitlist dropout. Region 11, which transplants at lower MELD scores, will have an increase in waitlist dropout from 30% to 44%. Conclusions The liver transplant waitlist size will remain static over the next decade due to patient dropout. Liver transplant candidates will be older, more likely to have NASH and will wait for transplantation longer even when listed at a competitive MELD score. There will continue to be significant heterogeneity among transplant regions where some patients will be more likely to drop out of the waitlist than receive a transplant.

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“…7 These data challenge LT physicians to reconsider increasing age as a contraindication to transplantation. As depicted by Su et al, 9 advancing age is associated with significantly increased risk of posttransplant mortality, with 8.7 and 10.6 deaths per 100 patient-years for transplant recipients ages 65-69 and 70, respectively. However, these decrements in posttransplant survival are counterbalanced by the increased risk of waitlist mortality for older patients, independent of other factors.…”

mentioning

confidence: 95%

“…That is why the work of Su et al is important. 9 Su et al evaluated national transplant data from 2002 to 2014 with 2 primary aims: describe trends in waitlisting for LT among older patients and assess the effect of age on transplant-related survival benefit. 9 The novelty of these analyses was the focus on 5-year transplant-related survival benefit, rather than solely focusing on the impact of increasing age on posttransplant survival.…”

mentioning

confidence: 99%

“…9 Su et al evaluated national transplant data from 2002 to 2014 with 2 primary aims: describe trends in waitlisting for LT among older patients and assess the effect of age on transplant-related survival benefit. 9 The novelty of these analyses was the focus on 5-year transplant-related survival benefit, rather than solely focusing on the impact of increasing age on posttransplant survival. This was achieved using competing risk models to estimate the association between age and waitlist mortality, Cox proportional hazards models to evaluate the association between age and posttransplant survival, and survival benefit calculated as the differences between waitlist and posttransplant life expectancies at 5 years.…”

mentioning

confidence: 99%

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Usefulness of Liver Transplantation in the Elderly: The Converging Impact of Risk and Benefit

Goldberg

Charlton

2016

Gastroenterology

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Aging of Liver Transplant Registrants and Recipients: Trends and Impact on Waitlist Outcomes, Post-Transplantation Outcomes, and Transplant-Related Survival Benefit

Cited by 166 publications

References 37 publications

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Usefulness of Liver Transplantation in the Elderly: The Converging Impact of Risk and Benefit

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