title: Is liver transplantation safe and effective in elderly (≥70 years) recipients? A case-controlled analysis.
abstract: BACKGROUND
  Elderly patients are evaluated for liver transplantation (LT) with increasing frequency, but outcomes in this group have not been well defined.
  
  
  METHODS
  A linkage of the Scientific Registry of Transplant Recipients (SRTR) and the University HealthSystem Consortium (UHC) databases identified 12,445 patients who underwent LT during 2007-2011. Two cohorts were created consisting of, respectively, elderly recipients aged ≥70 years (n = 323) and recipients aged 18-69 years (n = 12,122). A 1:1 case-matched analysis was performed based on propensity scores.
  
  
  RESULTS
  Elderly recipients had lower Model for End-stage Liver Disease (MELD) scores at LT (median 15 versus 19; P < 0.0001), more often underwent transplantation at high-volume centres (46% versus 33%; P < 0.0001) and more often received grafts from donors aged >60 years (24% versus 15%; P < 0.0001). The two cohorts had similar hospital lengths of stay, in-hospital mortality, hospital costs and 30-day readmission rates. There were no differences in graft survival between the two cohorts (P = 0.10), but elderly recipients had worse longterm overall survival (P = 0.009). However, a case-controlled analysis confirmed similar perioperative hospital outcomes, graft survival and longterm patient survival in the two matched cohorts.
  
  
  CONCLUSIONS
  Elderly LT recipients accounted for <3% of all LTs performed during 2007-2011. Selected elderly recipients have perioperative outcomes and survival similar to those in younger adults.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.forename: R Cutler
authors.initials: RC
authors.lastname: Quillin
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006085:Graft Survival; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
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