‘Age should not be a contraindication’ for liver transplant in older patients with ACLF
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Key takeaways:
- Older patients with ACLF had higher 30-day waitlist mortality compared with younger patients (20.4% vs. 16.7%).
- One-year, post-LT survival estimates among older adults with ACLF ranged from 77% to 86.4%.
Older adult patients with acute-on-chronic liver failure had significantly higher waitlist mortality but “acceptable” 1-year survival after liver transplantation, according to data in Clinical Gastroenterology and Hepatology.
“Data on patients older than 65 years who develop ACLF are currently lacking, especially the underlying etiology of ACLF, their mortality on the waitlist and survival rate following liver transplantation,” Joseph J. Alukal, MD, health sciences clinical professor in the department of internal medicine at the University of California Riverside School of Medicine, told Healio.
To determine clinical outcomes and characteristics of older patients listed for LT, Alukal and colleagues conducted an analysis of the UNOS database from 2005 to 2021. They identified 4,313 patients (14%) older than 65 years and 26,628 (86%) aged 18 to 64 years, of whom 49.6% and 63.5%, respectively, underwent transplantation.
Key results showed older patients had higher 30-day waitlist mortality compared with younger patients (20.4% vs. 16.7%), which was more pronounced among those with ACLF grade 2 (23.7% vs. 14.8%) and grade 3 (43.3% vs. 29.9%).
While younger patients had better survival across all grades of ACLF, Alukal noted 1-year post-LT survival estimates among older adults with ACLF grade 1, 2 and 3 “were excellent” at 86.4%, 85.5% and 77%, respectively, “indicating that transplantation in this population has important survival benefits.”
“Older patients with ACLF have significantly higher waitlist mortality compared to younger patients, despite having similar MELD scores,” Alukal told Healio. “Therefore, in a geriatric patient who develops ACLF, one should anticipate a poor prognosis, and the MELD score may be falsely reassuring.”
He continued: “At the same time, in carefully selected older adults with ACLF, liver transplantation is lifesaving and survival rates are acceptable, even in those with ACLF grade 3. Age should not be a contraindication for transplant in patients who develop ACLF.”
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