title: Increasing age and survival after orthotopic liver transplantation for patients with hepatocellular cancer.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is the gold standard treatment for patients with early hepatocellular carcinoma (HCC). There are concerns about the efficacy of OLT for HCC in older patients, who we hypothesized might have poorer outcomes. Therefore, we sought to examine advanced age and its impact on OLT outcomes.
  
  
  METHODS
  The United Network for Organ Sharing database was queried for patients who underwent OLT for HCC from 1987 to 2009. Patients were divided into 3 age groups: 35 to 49 years old, 50 to 64 years old, and 65 years or older, and patient characteristics were compared. Univariate and multivariate analyses were performed to assess the impact of age on OLT outcomes.
  
  
  RESULTS
  Of 10,238 patients with OLT for HCC, 16.5% (n = 1,688) of patients were 35 to 49 years old, 67.8% (n = 6,937) were 35 to 49 years old, and 15.8% (n = 1,613) were 65 years and older. By Kaplan-Meier method, the 50- to 64-year-old age group had the highest overall survival, despite having one of the highest rates of hepatitis C positivity (70%), but this group also had the lowest rate of diabetes mellitus (8.7%). The lowest overall survival was observed in the 65-year or older age group (p < 0.001). Finally, there was no difference in disease-specific survival among the age groups (p = 0.858), and patients aged 65 years and older had the highest rate of death from nonhepatic causes (17.5%).
  
  
  CONCLUSIONS
  Although OS was prolonged in younger patients who underwent OLT for HCC, there was no observed difference in disease-specific survival among the age groups. Our results suggest that carefully selected patients 65 years of age and older can derive equal benefit from OLT for HCC when compared with their younger counterparts.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA. Electronic address: jokim@coh.org.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Ko
authors.affiliation: Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Arrington
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Luu
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Falor
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Steven
authors.initials: S
authors.lastname: Colquhoun
authors.affiliation: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.affiliation: Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology