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Abstract Details
Nonalcoholic steatohepatitis is the most common indication for liver transplantation among the elderly: Data from the United States Scientific Registry of Transplant Recipients
Hepatol Commun. 2022 Feb 28. doi: 10.1002/hep4.1915. Online ahead of print.
Maria Stepanova12, Khaled Kabbara13, Denise Mohess4, Manisha Verma14, Alva Roche-Green4, Saleh AlQahtani25, Janus Ong26, Patrizia Burra27, Zobair M Younossi1238
Author information
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Division of Palliative Care and Geriatrics, Inova Health System, Falls Church, Virginia, USA.
Division of Gastroenterology and Hepatology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA.
College of Medicine, University of the Philippines, Manila, Philippines.
Department of Gastroenterology, Padua University, Padua, Italy.
Inova Medicine, Inova Health System, Falls Church, Virginia, USA.
Abstract
As the US population ages, more elderly patients may need liver transplantation. Our aim was to assess recent trends among elderly individuals requiring liver transplant in the United States. Scientific Registry of Transplant Recipients data (2002-2020) were used to select elderly (≥65 years) liver transplant candidates and assess on-list and posttransplant outcomes. During the study period, 31,209 liver transplant candidates ≥65 years were wait listed. Common etiologies included nonalcoholic steatohepatitis (NASH; 31%), hepatitis C (23%), and alcoholic liver disease (18%); 30% also had hepatocellular carcinoma (HCC). Over time, the proportion of patients ≥65 years among all adult liver transplant candidates increased from 9% (2002-2005) to 23% (2018-2020) (trend, p < 0.0001). The proportion of NASH among elderly candidates increased from 13% (2002-2005) to 39% (2018-2020). Of the elderly candidates, 54% eventually received transplants. In multivariate analysis, independent predictors of a higher chance of receiving a transplant for the elderly included more recent years of listing, male sex, higher Model for End-Stage Liver Disease (MELD) score, and HCC (all p < 0.01). Posttransplant mortality in elderly transplant recipients was higher than in younger patients but continued to decrease over time. In multivariate analysis, independent predictors of higher posttransplant mortality for elderly transplant recipients were earlier years of transplantation, older age, male sex, higher MELD score, history of diabetes, retransplantation, and having HCC (all p < 0.01). The proportion of elderly patients in need of liver transplantation in the United States is sharply increasing. NASH is the most common indication for liver transplantation among the elderly. The outcomes of these patients have been improving in the past 2 decades.