title: Outcomes among older adult liver transplantation recipients in the model of end stage liver disease (MELD) era.
abstract: BACKGROUND
  Since 2002, the Model of End Stage Liver Disease (MELD) score has been the basis of the liver transplant (LT) allocation system. Among older adult LT recipients, short-term outcomes in the MELD era were comparable to the pre-MELD era, but long-term outcomes remain unclear.
  
  
  METHODS
  This is a retrospective cohort study using the UNOS data on patients age ≥ 50 years who underwent primary LT from February 27, 2002 until October 31, 2011.
  
  
  RESULTS
  A total of 35,686 recipients met inclusion criteria. The cohort was divided into 5-year interval age groups. Five-year over-all survival rates for ages 50-54, 55-59, 60-64, 65-69, and 70+ were 72.2%, 71.6%, 69.5%, 65.0%, and 57.5%, respectively. Five-year graft survival rates after adjusting for death as competing risk for ages 50-54, 55-59,60-64, 65-69 and 70+ were 85.8%, 87.3%, 89.6%, 89.1% and 88.9%, respectively. By Cox proportional hazard modeling, age ≥ 60, increasing MELD, donor age ≥ 60, hepatitis C, hepatocellular carcinoma (HCC), dialysis and impaired pre-transplant functional status (FS) were associated with increased 5-year mortality. Using Fine and Gray sub-proportional hazard modeling adjusted for death as competing risk, 5-year graft failure was associated with donor age ≥ 60, increasing MELD, hepatitis C, HCC, and impaired pre-transplant FS.
  
  
  CONCLUSIONS
  Among older LT recipients in the MELD era, long-term graft survival after adjusting for death as competing risk was improved with increasing age, while over-all survival was worse. Donor age, hepatitis C, and pre-transplant FS represent potentially modifiable risk factors that could influence long-term graft and patient survival.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
authors.forename: Maricar F
authors.initials: MF
authors.lastname: Malinis
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
authors.forename: Shu
authors.initials: S
authors.lastname: Chen
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Quagliarello
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology