title: Liver transplantation trends for older recipients: regional and ethnic variations.
abstract: BACKGROUND
  Liver transplantation (LT) provides long-term survival for adults with end-stage liver disease. As a result of improved survival and an aging United States population the demand for LT in older patients is expected to increase. The aim of this study was to describe the transplantation trends in the older recipient (older than 65 years).
  
  
  METHODS
  Using the United Network for Organ Sharing database, we identified LT recipients between 1990 and 2006. We used Kaplan-Meier method to calculate overall survival (1, 3, 5 and 10 years) and Cox regression for predictors of survival.
  
  
  RESULTS
  During the study period 5630 (7.6%) LT recipients were older than 65 years. There were 4256 (79.4%) whites, Hispanic (10.3%), African Americans (AA) (3.6%), and rest (6.7%). There was an increase in LT for older than 65 years from 4.1% in 1990 to 10.2% in 2006 (P=0.002) and a regional variation (P<0.001). The 10-year patient and graft survival was 60% and 57% for less than 65 years versus 42% and 40% for more than 65 years (P<0.0001). With age stratification (65-75 years vs. >75 years), there was no difference in survival but when adjusted for race there was a significant difference in graft survival with a 10 year (white 40%, Hispanic 44%, and AA 19%) (P=0.04).
  
  
  CONCLUSIONS
  The demand for LT in recipients older than 65 years is increasing. Although their survival is lower in comparison with recipients less than 65 years, there seems to be no difference in unadjusted survival with age stratification above 65 years. Among ethnic minorities, there was a disproportionately lower percentage of African Americans LT and a decreased survival.
authors.affiliation: University of Cincinnati, Cincinnati, OH 45267-0595, USA. Nyingi.Kemmer@uc.edu
authors.forename: Nyingi
authors.initials: N
authors.lastname: Kemmer
authors.forename: Kamran
authors.initials: K
authors.lastname: Safdar
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Kaiser
authors.forename: Victoria
authors.initials: V
authors.lastname: Zacharias
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000208:ethnology / Q000401:mortality / Q000639:trends*; D008297:Male; D018579:Patient Selection; D016016:Proportional Hazards Models; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data