title: Liver transplantation for unresectable hepatocellular carcinoma in elderly patients: what to expect.
abstract: BACKGROUND
  Elderly patients have orthotopic liver transplantation (OLT) outcomes comparable to younger individuals. However, it is undefined whether such results are also seen in those with unresectable hepatocellular carcinoma (HCC). The primary endpoints of this study were overall survival (OS), retransplantation rate, and disease-free survival (DFS) in OLT recipients with HCC and aged ≥65 years compared with those aged <65 years.
  
  
  METHODS
  This was a single-center retrospective review of a cohort of adult deceased-donor OLT recipients due to unresectable HCC within the Milan criteria from May 2006 through March 2013. Demographic and clinical variables and outcomes of patients aged ≥65 years were compared with those aged <65 years.
  
  
  RESULTS
  Thirty-seven individuals ≥65 years of age (group 1) and 141 individuals <65 years of age (group 2) were analyzed. OS (group 1 vs group 2) at 1 year (78% vs 81%), 3 years (64% vs 70%), and 5 years (64% vs 66%) (P = .49) was comparable. Retransplantation rates were also similar (group 1: 13.5%; group 2, 10.6% [P = .61]). DFS (group 1 vs group 2) at 1 year (100% vs 95%), 3 years (91% vs 92%), and 5 years (91% vs 92%) (P = .56) was also not significantly different between groups. On multivariate analysis, age >65 years was not an independent predictor of OS or DFS.
  
  
  CONCLUSIONS
  Patients aged ≥65 years with HCC presented with outcomes similar to their younger counterparts. Chronologic age is not a good predictor of outcome, and transplantation is feasible if overall clinical conditions and comorbidities allow.
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: gfelga@einstein.br.
authors.forename: G
authors.initials: G
authors.lastname: Felga
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Silva Evangelista
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: P
authors.initials: P
authors.lastname: Rogério de Oliveira Salvalaggio
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Bruno de Rezende
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Dias de Almeida
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome