Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma

The national experience

Jason J. Schwartz, Lisa Pappas, Heather F. Thiesset, Gabriela Vargas, John B. Sorensen, Robin D. Kim, William R. Hutson, Kenneth Boucher, Terry Box

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or ≥ 70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10% to 15% depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4%, 83.2%, 79.6%, 76.1%, and 72.7%, respectively, for the patients who were younger than 70 years and 81.1%, 73.8%, 67.1%, 61.9%, and 55.2%, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age.

    Original languageEnglish (US)
    Pages (from-to)423-433
    Number of pages11
    JournalLiver Transplantation
    Volume18
    Issue number4
    DOIs
    StatePublished - Apr 2012

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    End Stage Liver Disease
    Liver Transplantation
    Hepatocellular Carcinoma
    Survival Rate
    Transplantation
    Transplants
    Liver
    Tissue and Organ Procurement
    Survival
    Organized Financing
    Organ Transplantation
    Nonparametric Statistics
    Age Groups

    ASJC Scopus subject areas

    • Surgery
    • Transplantation
    • Hepatology

    Cite this

    Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma : The national experience. / Schwartz, Jason J.; Pappas, Lisa; Thiesset, Heather F.; Vargas, Gabriela; Sorensen, John B.; Kim, Robin D.; Hutson, William R.; Boucher, Kenneth; Box, Terry.

    In: Liver Transplantation, Vol. 18, No. 4, 04.2012, p. 423-433.

    Research output: Contribution to journalArticle

    Schwartz, JJ, Pappas, L, Thiesset, HF, Vargas, G, Sorensen, JB, Kim, RD, Hutson, WR, Boucher, K & Box, T 2012, 'Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience', Liver Transplantation, vol. 18, no. 4, pp. 423-433. https://doi.org/10.1002/lt.23385
    Schwartz, Jason J. ; Pappas, Lisa ; Thiesset, Heather F. ; Vargas, Gabriela ; Sorensen, John B. ; Kim, Robin D. ; Hutson, William R. ; Boucher, Kenneth ; Box, Terry. / Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma : The national experience. In: Liver Transplantation. 2012 ; Vol. 18, No. 4. pp. 423-433.
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    abstract = "Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or ≥ 70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10{\%} to 15{\%} depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4{\%}, 83.2{\%}, 79.6{\%}, 76.1{\%}, and 72.7{\%}, respectively, for the patients who were younger than 70 years and 81.1{\%}, 73.8{\%}, 67.1{\%}, 61.9{\%}, and 55.2{\%}, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age.",
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