Aging among those awaiting liver transplant won't worsen outcomes

Last Updated: 2015-11-16

By Anne Harding

NEW YORK (Reuters Health) - Liver transplant registrants have gotten older over the past decade, on average, due to aging of people with hepatitis C virus (HCV) and increases in the prevalence of non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC), according to new findings.

And the current system prioritizes transplantation for some patients with HCC who will see a far lower survival benefit than transplant candidates without HCC, Dr. George Ioannou of Veterans Affairs Puget Sound Health Care System in Seattle, one of the new study's authors, told Reuters Health by email.

To examine trends in aging among liver transplant registrants and recipients and the impact of these trends on outcomes, Dr. Ioannou and his team looked at United Network for Organ Sharing (UNOS) data on 122,606 patients who were listed for liver transplant and 60,820 who received transplants from 2002-2014 in the United States.

Over the study period, registrants' mean age increased from 51.2 to 55.7 years. The increase was more pronounced among HCV-positive registrants, whose average age increased from 50.9 to 57.9 years, compared to 51.3 to 54.3 years for the HCV-negative registrants. The proportion of registrants who were at least 60 years old increased from 19% in 2002 to 41% in 2014.

During the study period, the percentage of transplant registrants with NASH increased from 2% to 13%, while the prevalence of HCC increased from 13% to 27% among registrants, according to an article online October 29 in Gastroenterology.

The older a registrant was, the more likely the person would die before receiving a transplant and the less likely to undergo liver transplantation. Researchers also found an association between age and increased mortality for liver transplant recipients. However, the five-year transplant-related survival benefit was similar across age groups for people with similar Model for End-Stage Liver Disease (MELD) scores.

"This suggests that age itself should not be a criterion for liver transplant eligibility and that the dramatic aging of liver transplant recipients that we describe should not be expected to have negative effect on transplant-related survival benefit," the researchers write.

Age was more strongly related to mortality risk in patients without HCC compared to those with HCC, while it was also more pronounced in UNOS regions with longer wait times versus shorter wait times.

"We are going to explore and promote the 'transplant-related survival benefit' as the best metric for prioritizing liver transplantation, especially in patients with HCC," Dr. Ioannou said. This benefit is calculated as the life expectancy of a patient with transplantation minus his or her life expectancy without transplantation. "Thus, it gives a measure of how much lifetime is gained by transplantation," he said.

"If every time a liver transplant is performed we select the patient with the highest 'transplant-related survival benefit,'" Dr. Ioannou added, "that will maximize the overall survival of all patients on the waitlist and by extension all patients in need of transplantation, which is ultimately what we want to achieve with transplantation."

The authors reported no external funding and no disclosures.

SOURCE: http://bit.ly/1YdH8La

Gastroenterol 2015.