Recipient age and mortality after liver transplantation: a population-based cohort tudy

Background The feasibility of liver transplantation (LT) in elderly recipients remains a topic of debate. Methods This cohort study evaluated the impact of recipient's age on LT outcome between January 2007 and May 2016 covered by the Korean National Health Insurance system (n = 9415). Multilevel regression models were used to determine the impact of recipient's age on in-hospital and long-term mortality after LT. Results All patients had a first LT, with 2,473 transplanted with liver from deceased donors (DD) and 6,942 from living donors (LD). The mean age was 52.2±9.0 years. The majority of LT was performed on patients in their 50s (n=4290, 45.6%) and 0.9% (n=84) of the LT was performed on patients aged over 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%. The in-hospital mortality included, 13.5% associated with DDLT and 3.7% involved LDLT. When compared with that for patients aged 51 to 55 years, the risk of death among recipients aged over 70 years was about four-fold higher after adjusting for baseline liver disease (OR 4.1; 95% CI 2.21-7.58), and was nearly 3 fold higher after adjusting for baseline liver disease and perioperative complications (OR 2.92; 95% CI 1.37-6.24). And the cost of LT increased significantly with age. Conclusions The data shows that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address for Correspondence: Jinkyeong Park, M.D. Ph.D. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, E-mail: pjk3318@gmail.com Authorship E.Gil participated in its design and drafted the manuscript. JM. Kim, K.Jeon and GY. Seo participated in its design and coordination. H.Park and D.Kang performed the statistical analysis and helped to draft the manuscript. And J.Cho directed the statistical analysis form the HIRA database. J.Park participated in its design and coordination and contributed as a corresponding author. Disclosure: none Ethics approval and consent to participate The study was reviewed by the Institutional Review Board (IRB) of Samsung Medical Center (IRB SMC 2017-01-001) and was exempted because it involved only deidentified administrative data collected previously. Availability of data and materials We cannot share our data because of administrative data of Korean government Funding: This study was supported by Samsung Medical Center grant [#SMX1151381] Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LzS0BK