Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Abstract

Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n = 54; patients older than 60 years, n = 57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p = 0.03) and hepatocellular carcinoma (p = 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p = 0.004 and p = 0.05, respectively). After transplantation, older patients had a significantly lower survival (p = 0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1-4.0; p = 0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p = 0.02 and p = 0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p = 0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.