Okumura K, Lee JS, Dhand A, Sogawa H, Veillette G, John D, Misawa R, Bodin R, Wolf DC, Diflo T, Nishida S. Trends and outcomes of liver transplantation among older recipients in the United States. World J Transplant 2022; 12(8): 259-267 [PMID: 36159074 DOI: 10.5500/wjt.v12.i8.259]
Corresponding Author of This Article
Kenji Okumura, MD, Department of Surgery, Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, NY 10595, United States. kenji.okumura@wmchealth.org
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Aug 18, 2022; 12(8): 259-267 Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.259
Trends and outcomes of liver transplantation among older recipients in the United States
Kenji Okumura, Joon Sub Lee, Abhay Dhand, Hiroshi Sogawa, Gregory Veillette, Devon John, Ryosuke Misawa, Roxana Bodin, David C Wolf, Thomas Diflo, Seigo Nishida
Kenji Okumura, Joon Sub Lee, Abhay Dhand, Hiroshi Sogawa, Gregory Veillette, Devon John, Ryosuke Misawa, Roxana Bodin, David C Wolf, Thomas Diflo, Seigo Nishida, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, United States
Author contributions: Okumura K, Nishida S contributed to the study design, data analysis, data interpretation, and writing manuscript; Lee JS, Dhand A, Sogawa H, Veillette G, John D, Misawa R, Bodin R, Wolf DC, and Diflo T revised manuscript and critical revisions; and all authors approved the final version of the manuscript.
Institutional review board statement: All study methods were approved by our Institutional Review Board.
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data is available on request from the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kenji Okumura, MD, Department of Surgery, Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, NY 10595, United States. kenji.okumura@wmchealth.org
Received: January 16, 2022 Peer-review started: January 16, 2022 First decision: March 16, 2022 Revised: March 30, 2022 Accepted: July 31, 2022 Article in press: July 31, 2022 Published online: August 18, 2022 Processing time: 213 Days and 7.8 Hours
ARTICLE HIGHLIGHTS
Research background
The average age of liver transplant and the number of liver transplant in the older recipients is increasing.
Research motivation
We wanted to investigate the outcomes of expansion of criteria of liver transplantation (LT) with increasing inclusion of older recipients and donors. We also wanted to identify any potentially modifiable risk factors that may be associated lower with graft or patient survival.
Research objectives
We compared one, three- and five-year graft and patient survival between two groups of liver transplant recipients: Younger group (18-64 years old) and older group (≥ 65 years old) between the period of 1987-2019 in the United States.
Research methods
We analyzed data from the United Network for Organ Sharing database between 1987-2019. The sample was split into younger group (18-64 years old) and older group (≥ 65 years old).
Research results
The number of LT for older patients was highest in 2019 (1920). In the older group, the percentage of non-alcoholic steatohepatitis and hepatocellular carcinoma as the primary etiology for LT was higher than younger group compared to the older group (16.4 % vs 5.9%; 14.9% vs 6.9%). On univariable analysis, there was no difference in post-transplant length of hospitalization, one-year and five-year overall survivals between the two groups. On multivariable Cox-Hazard regression analysis for graft survival, older group (hazard ratio: 1.27, P < 0.001) had higher risk of graft failure which was associated with male gender, pre-transplant diabetes, previous history of LT, ventilation at the time of LT, high model for end-stage liver disease score, recipient portal vein thrombosis, hepatitis C virus positive status, and higher donor risk index.
Research conclusions
Older age alone should not be considered to be a contraindication for LT.
Research perspectives
Careful evaluation process and postoperative care are necessary to improve transplant outcomes.
