Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

Abstract

Background: With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short-and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group. Methods: All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3-and 5-year survival. Results: Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1-and 3-year survival was similar, the 5-year survival was significantly lower in group 1. Conclusion: Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.

Survival after LDLT in recipients ≥70 years old in the United States. An OPTN/UNOS liver transplant registry analysis

“…This finding remained comparable when analyzing LDLT recipients ≥70y versus those <70y. This is in alignment with previous reports showing similar incidence of vascular and biliary complications between elderly LDLT recipients when compared to younger LDLT recipients 31 . In addition, our study is the largest cohort to date of such elderly population.…”

“…However, as specific comparison between older and younger recipients was not performed 28 . Most of the other reported experience is from single center reports, evaluating outcomes of adults ≥60–65y compared to younger LDLT recipients 29–36 . The present study is the first, to the best of our knowledge, specifically comparing outcomes of adult recipients ≥70y old undergoing LDLT versus DDLT.…”

Liver Transplant Outcomes in India

“…4 Same survival has been reported by other centers; however, survival is inferior in recipients older than 60 years. 5,6 Studies from our center showed similar survival in patients with MELD scores of <25 and ≥25 and in patients with low GRWR (with selective use of portal inflow modulation). 7,8 In a large cohort of 405 patients with cirrhosis and HCC (accepted for LDLT using our expanded selection criteria), the 5-year recurrence-free survival was 70%.…”

Impact of donor age on recipient morbidity and mortality after living donor liver transplantation

“…Evidence for the use of older donors in LDLT has been conflicting. Several studies have shown comparable outcomes between use of older and younger donors 2–5 while other authors have demonstrated contradictory findings 6–13 . Given the lack of consensus on the use of older donors, this study aims to investigate the impact of donor age on recipient morbidity and mortality after primary adult to adult LDLT.…”

“…Several studies have shown comparable outcomes between use of older and younger donors [2][3][4][5] while other authors have demonstrated contradictory findings. [6][7][8][9][10][11][12][13] Given the lack of consensus on the use of older donors, this study aims to investigate the impact of donor age on recipient morbidity and mortality after primary adult to adult LDLT. groups according to donor age: donors in 20s (D-20s) group, donors in 30s and 40s (D-30s and 40s) group and donors in 50s and 60s (D-50s &and 60s) group.…”