Liver Transplantation Survival Rates Lower in Recipients Aged 70 Years and Older

Surgeons performing liver transplant. Samsung Medical Center, Seoul, South Korea.
Researchers sought to determine postliver transplantation outcomes among adults aged 70 years and older.

Patients aged 70 years and older who undergo a liver transplantation may have significantly lower 1-year and 5-year survival rates compared with patients aged younger than 70 years, according to study results published in the Annals of Hepatology.

The systematic review and meta-analysis assessed outcome data among liver transplant recipients aged 70 years and older. Researchers searched several databases from inception to March 2022 for relevant studies. Researchers also used the random-effects model for the meta-analysis and I2 statistics to determine heterogeneity. The primary outcomes were the pooled rate of post-transplant survival at 1 year, 3 years, and 5 years.

Of 7319 studies assessed, 10 studies were included in the final analysis; 4752 patients were aged 70 years and older and 157,973 were aged younger than 70 years.

The pooled rate for survival among liver transplant patients aged 70 years and older was 78.7% at 1 year (95% CI, 72.6-83.7; I2=74%), 61.2% at 3 years (95% CI, 52.3-69.5; I2=87%), and 48.9% at 5 years (95% CI, 39.3-58.6; I2=96%).

The post-transplant survival rates for patients aged younger than 70 years were 86.6% at 1 year (95% CI, 82.4-89.9; I2=99%), 73.2% at 3 years (95% CI, 63-81.3; I2=99%), and 70.1% at 5 years (95% CI, 66.8-73.2; I2=99%). The descriptive P values of comparison were statistically significant for post-transplant survival outcomes at 1 year (P =.02) and 5 years (P <.001).

The pooled rate of perioperative complications resulting from liver transplantation among patients aged 70 years and older was 40.7% (95% CI, 26.2-57; I2=93%). The pooled rate of graft failure in patients aged 70 years and older was 6.7% (95% CI, 3.3-13.1; I2=93%), and the rate in patients aged younger than 70 years was 3.7% (95% CI, 1-12.4; I2=99%). The pooled rate of perioperative mortality in patients aged 70 years and older was 16.6% (95% CI, 7.6-32.5; I2=99%), compared with 0.8% in patients aged younger than 70 years (95% CI 0-33.1; I2=88%).

For mean hospital length of stay in patients aged 70 years and older, the pooled rate was 30.5 days (95% CI, 19.6-41.2; I2=99%), and in patients aged younger than 70 years the rate was 18.7 days (95% CI, 1-37.8; I2=99%) (P =.3). The pooled intensive care unit (ICU) length of stay in patients aged 70 years and older was 8.9 days (95% CI, 1.3-16.6; I2=99%). Insufficient data were available for patients aged younger than 70 years regarding ICU stay.

Study limitations included inherent bias and a high degree of heterogeneity. Also, older adult patients more frequently received a transplant at high-volume centers, and the results might not represent outcomes in the general community. In addition, some data were limited in patients aged younger than 70 years, and it is unknown if the perioperative complications were different in the 2 groups.

“Further well-conducted studies with good sample size and adequate follow-up time are warranted to establish our findings,” the study authors wrote.

Reference

Mohan BP, Iriana S, Khan SR, Yarra P, Ponnada S, Gallegos-Orozco JF. Outcomes of liver transplantation in patients 70 years or older: a systematic review and meta-analysis. Ann Hepatol. 2022;27(6):100741. doi:10.1016/j.aohep.2022.100741