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©The Author(s) 2022.
World J Transplant. Aug 18, 2022; 12(8): 259-267
Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.259
Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.259
Table 1 Baseline characteristics of the study population comparing age young group (age 18-64) vs older group (age ≥ 65 years)
| Young group, age 18-64 (n = 135758) | Older group, age ≥ 65 (n = 20000) | P value | |
| Age (IQR) | 52 (45-58) | 67 (66-69) | < 0.001 |
| Female, n (%) | 47934 (35.3) | 7612 (38.1) | < 0.001 |
| Race, % | < 0.001 | ||
| White | 73.5 | 75.5 | |
| Black | 8.9 | 6.0 | |
| Hispanic/Latino | 12.5 | 12.1 | |
| Asian | 3.8 | 5.4 | |
| Others | 1.3 | 0.9 | |
| BMI (IQR) | 27.4 (24.0-31.7) | 27.7 (24.5-31.5) | 0.571 |
| HCV, % | 44876 (33.1) | 5236 (26.2) | < 0.001 |
| Diabetes, n (%) | 226584 (22.3) | 6784 (35.7) | < 0.001 |
| L1-MELD | 18 (12-26) | 15 (10-22) | < 0.001 |
| R2-MELD | 21 (14-30) | 18 (12-26) | < 0.001 |
| Primary disease, % | |||
| Alcohol cirrhosis | 22.3 | 15.3 | < 0.001 |
| HCV cirrhosis | 25.2 | 19.0 | < 0.001 |
| NASH | 5.9 | 16.4 | < 0.001 |
| HCC | 6.9 | 14.9 | < 0.001 |
| Acute liver failure | 5.2 | 2.5 | < 0.001 |
| Acute alcoholic hepatitis | 0.35 | 0.13 | < 0.001 |
| Previous surgery, n (%) | 48407 (35.7) | 8899 (44.5) | < 0.001 |
| SBP, n (%) | 9147 (6.7) | 1084 (5.4) | < 0.001 |
| TIPSS, n (%) | 7231 (5.3) | 1187 (5.9) | 0.001 |
| Portal vein thrombosis, n (%) | 4875 (3.6) | 1162 (5.8) | < 0.001 |
| Mechanical ventilation, n (%) | 10464 (7.6) | 888 (4.3) | < 0.001 |
| Dialysis, n (%) | 14284 (10.5) | 2059 (10.3) | 0.167 |
| Wait days, d (IQR) | 82 (16-263) | 118 (27-310) | < 0.001 |
| Re-transplant, n (%) | 10125 (7.5) | 727 (3.6) | < 0.001 |
Table 2 Donor characteristics and post-transplant outcomes
| Young, age 18-64 (n = 135758) | Older, age ≥ 65 (n = 20000) | P value | |
| Donor age (IQR) | 38 (24-52) | 43 (28-56) | < 0.001 |
| Donor female, n (%) | 53967 (39.8) | 8434 (42.2) | < 0.001 |
| Donor race, % | < 0.001 | ||
| White | 70.3 | 68.2 | |
| Black | 14.6 | 15.5 | |
| Hispanic/Latino | 11.6 | 12.4 | |
| Asian | 2.1 | 2.4 | |
| Others | 1.4 | 1.6 | |
| Donor BMI (IQR) | 25.6 (22.5-29.5) | 26.2 (23.0-30.3) | < 0.001 |
| Donor HCV, n (%) | 4912 (3.6) | 907 (4.5) | < 0.001 |
| Cold ischemia time, h (IQR) | 6.9 (5.0-9.0) | 6.1 (4.8-8.0) | < 0.001 |
| Donor risk index (IQR) | 1.53 (1.35-1.81) | 1.61 (1.38-1.94) | < 0.001 |
| Outcomes | |||
| LOS, d (IQR) | 11 (7-20) | 10 (7-19) | 0.261 |
| Graft survival rate, (%) | |||
| 1 yr | 84.0 | 84.1 | 0.416 |
| 3 yr | 77.0 | 77.1 | 0.206 |
| 5 yr | 72.6 | 72.9 | 0.010 |
| Overall survival rate | |||
| 1 yr | 88.6 | 86.5 | < 0.001 |
| 3 yr | 82.5 | 79.5 | < 0.001 |
| 5 yr | 78.3 | 75.1 | < 0.001 |
Table 3 Multivariable cox regression for five-year graft survival
| Variables | B (SE) | Hazard ratio (95%CI) | P value |
| Year of transplant | -0.04 (0.002) | 0.958 (0.955-0.961) | < 0.001 |
| Age ≥ 65 | 0.24 (0.02) | 1.27 (1.22-1.32) | < 0.001 |
| Male | 0.10 (0.02) | 1.11 (1.08-1.14) | < 0.001 |
| BMI (per10) | -0.05 (0.01) | 0.95 (0.93-0.98) | 0.001 |
| Race | 0.001 | ||
| Caucasian | Ref | 1.0 (Ref) | |
| African American | 0.23 (0.02) | 1.26 (1.21-1.31) | < 0.001 |
| Hispanic | -0.11 (0.02) | 0.90 (0.86-0.94) | < 0.001 |
| Asian | -0.21 (0.04) | 0.81 (0.75-0.87) | < 0.001 |
| Pre-LT diabetes | 0.20 (0.02) | 1.22 (1.18-1.26) | < 0.001 |
| Ventilation | 0.51 (0.03) | 1.67 (1.59-1.76) | < 0.001 |
| Pre-LT dialysis | 0.20 (0.02) | 1.23 (1.17-1.28) | < 0.001 |
| Retransplant | 0.44 (0.03) | 1.55 (1.47-1.63) | < 0.001 |
| PVT | 0.21 (0.03) | 1.23 (1.16-1.31) | < 0.001 |
| R1-MELD (per 10) | 0.04 (0.01) | 1.05 (1.03-1.06) | < 0.001 |
| HCV recipient | 0.28 (0.01) | 1.33 (1.29-1.36) | < 0.001 |
| Donor race | < 0.001 | ||
| Caucasian | Ref | 1.0 (Ref) | |
| African American | 0.06 (0.02) | 1.06 (1.02-1.10) | 0.001 |
| Hispanic | 0.10 (0.02) | 1.11 (1.06-1.16) | < 0.001 |
| Asian | 0.19 (0.04) | 1.21 (1.11-1.31) | < 0.001 |
| Donor risk index | 0.34 (0.03) | 1.41 (1.34-1.48) | < 0.001 |
| Cold ischemia time | 0.014(0.002) | 1.014 (1.010-1.019) | < 0.001 |
Table 4 Multivariable cox regression for five-year graft survival in older group
| Variables | B (SE) | Hazard ratio (95%CI) | P value |
| Year of transplant | -0.05 (0.004) | 0.954 (0.947-0.961) | < 0.001 |
| Male | 0.19 (0.04) | 1.21 (1.12-1.30) | < 0.001 |
| Re-transplant | 0.41 (0.08) | 1.50 (1.28-1.76) | < 0.001 |
| Pre-LT diabetes | 0.17 (0.04) | 1.18 (1.10-1.27) | < 0.001 |
| Ventilation | 0.42 (0.08) | 1.52 (1.30-1.76) | < 0.001 |
| Portal vein thrombosis | 0.18 (0.07) | 1.20 (1.05-1.36) | 0.006 |
| MELD (per 10) | 0.13 (0.02) | 1.14 (1.10-1.18) | < 0.001 |
| HCV Recipient | 0.21 (0.04) | 1.23 (1.15-1.33) | < 0.001 |
| Donor age (per 10) | 0.03 (0.01) | 1.03 (1.002-1.054) | 0.032 |
| Donor risk index | 0.25 (0.06) | 1.29 (1.15-1.44) | < 0.001 |
| Cold ischemia time | 0.017 (0.006) | 1.02 (1.01-1.03) | 0.003 |
- Citation: 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
- URL: https://www.wjgnet.com/2220-3230/full/v12/i8/259.htm
- DOI: https://dx.doi.org/10.5500/wjt.v12.i8.259