Posttransplant Outcomes in Older Patients With Hepatocellular Carcinoma Are Driven by Non–Hepatocellular Carcinoma Factors

Nia Adeniji, Vinodhini Arjunan, Vijay Prabhakar, Ajitha Mannalithara, Tara Ghaziani, Aijaz Ahmed, Paul Kwo, Mindie Nguyen, Marc L. Melcher, Ronald W. Busuttil, Sander S. Florman, Brandy Haydel, Richard M. Ruiz, Goran B. Klintmalm, David D. Lee, C. Burcin Taner, Maarouf A. Hoteit, Elizabeth C. Verna, Karim J. Halazun, Amit D. TevarAbhinav Humar, William C. Chapman, Neeta Vachharajani, Federico Aucejo, Trevor L. Nydam, James F. Markmann, Constance Mobley, Mark Ghobrial, Alan N. Langnas, Carol A. Carney, Jennifer Berumen, Gabriel T. Schnickel, Debra L. Sudan, Johnny C. Hong, Abbas Rana, Christopher M. Jones, Thomas M. Fishbein, Vatche Agopian, Renumathy Dhanasekaran

Research output: Contribution to journalArticlepeer-review

Abstract

The incidence of hepatocellular carcinoma (HCC) is growing in the United States, especially among the elderly. Older patients are increasingly receiving transplants as a result of HCC, but the impact of advancing age on long-term posttransplant outcomes is not clear. To study this, we used data from the US Multicenter HCC Transplant Consortium of 4980 patients. We divided the patients into 4 groups by age at transplantation: 18 to 64 years (n = 4001), 65 to 69 years (n = 683), 70 to 74 years (n = 252), and ≥75 years (n = 44). There were no differences in HCC tumor stage, type of bridging locoregional therapy, or explant residual tumor between the groups. Older age was confirmed to be an independent and significant predictor of overall survival even after adjusting for demographic, etiologic, and cancer-related factors on multivariable analysis. A dose-response effect of age on survival was observed, with every 5-year increase in age older than 50 years resulting in an absolute increase of 8.3% in the mortality rate. Competing risk analysis revealed that older patients experienced higher rates of non–HCC-related mortality (P = 0.004), and not HCC-related death (P = 0.24). To delineate the precise cause of death, we further analyzed a single-center cohort of patients who received a transplant as a result of HCC (n = 302). Patients older than 65 years had a higher incidence of de novo cancer (18.1% versus 7.6%; P = 0.006) after transplantation and higher overall cancer-related mortality (14.3% versus 6.6%; P = 0.03). Even carefully selected elderly patients with HCC have significantly worse posttransplant survival rates, which are mostly driven by non–HCC-related causes. Minimizing immunosuppression and closer surveillance for de novo cancers can potentially improve the outcomes in elderly patients who received a transplant as a result of HCC.

Original languageEnglish (US)
Pages (from-to)684-698
Number of pages15
JournalLiver Transplantation
Volume27
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • Aged
  • Carcinoma, Hepatocellular/epidemiology
  • Humans
  • Liver Neoplasms/epidemiology
  • Liver Transplantation/adverse effects
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • United States/epidemiology

ASJC Scopus subject areas

  • Transplantation
  • Surgery
  • Hepatology

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