Disparities in waitlist and posttransplantation outcomes in liver transplant registrants and recipients 18-24 years old: analysis of the UNOS database.

Background: We evaluated liver transplantation waitlist and posttransplantation outcomes in 18-24 year olds compared to both younger (0-17 year old) and older (25-34 year old) registrants and recipients. Methods: Utilizing national data from the United Network for Organ Sharing, competing risk, Cox regression and Kaplan-Meier analyses were performed on first-time liver transplant registrants (n=13,979) and recipients (n=8,718) ages 0-34 years old between 2002 to 2015. Results: Among nonStatus 1A registrants, both 0-17 and 25-34 year olds were less likely to experience drop-out from the waiting list compared to 18-24 year olds (adjusted hazard ratio [AHR] 0-5 year olds=0.36, 6-11=0.29, 12-17=0.48, 18-24=1.00, 25-34=0.82). Although there was no difference in risk of graft failure across all age groups, both younger and older age groups had significantly lower risk of posttransplant mortality compared to 18-24 year olds (AHR for 0-5 year olds=0.53, 6-11=0.48, 12-17=0.70, 18-24=1.00, 25-34=0.77). This may be related to lower likelihood of re-transplantation after graft failure in 18-24 year olds. Conclusions: This national registry study demonstrates for the first time poorer waitlist and postliver transplant outcomes in young adults ages 18-24 years at the time of listing and transplantation compared to older and younger age groups. Given the potential survival benefit in transplanting young adults and the shortage of solid organs for transplant, future studies are critical to identify and target modifiable risk factors to improve waitlist and long-term posttransplant outcomes in 18-24 year old registrants and recipients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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