Combined effects of recipient age and model for end-stage liver disease score on liver transplantation outcomes.
BACKGROUND
The proportion of older patients awaiting liver transplantation (LT) is rising. Although increased age and LT-MELD are known to increase the risk of graft loss, no studies have explored whether there is a synergistic effect between LT-age and LT-MELD.


METHODS
All US adult, non-Status 1 recipients of primary deceased donor LT from 2/05 to 1/10 without MELD exceptions were included (n=15,677). Recipients were categorized by LT-age [18-59 yr (n=11,966), 60-64 yr (n=2181), 65-69 yr (n=1177), and ≥70 yr (n=343)] and LT-MELD [low (<20, n=5290), mid (20-27, n=5112), and high (≥28, n=5265)]. Adjusted Cox models evaluated the independent and combined effects of LT-age and LT-MELD on graft loss (death or re-LT).


RESULTS
LT-age ≥70 yr (HR=1.65, 95% CI 1.08-1.82) and LT-MELD ≥28 (HR=1.46, 95% CI 1.02-1.47) were independently associated with increased risk of graft loss (P<0.001). In a model allowing for the interaction between LT-age and LT-MELD, the risk of graft loss for recipients ≥70 years with MELD ≥28 was higher than predicted by the additive model (HR=2.38, 95% CI 1.73-3.27, P<0.001) resulting in 1-year graft survival of 56%. However, the increased risk of graft loss in recipients ≥70 years was attenuated at lower LT-MELD <28. Furthermore, the interaction term was not significant for any other LT-age and LT-MELD combination.


CONCLUSIONS
Our analyses suggest that recipients should not be excluded solely based on age; however, LT for recipients ≥70 years at high LT-MELD scores should be undertaken cautiously.
1 Department of Medicine, University of California, San Francisco, CA. 2 Department of Surgery, University of California, San Francisco, CA. 3 Address correspondence to: Jennifer C. Lai, M.D., M.B.A., 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA 94143.
Suzanne R
SR
Sharpton
Sandy
S
Feng
Bilal
B
Hameed
Francis
F
Yao
Jennifer C
JC
Lai
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult