Liver transplantation for unresectable hepatocellular carcinoma in elderly patients: what to expect

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.

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.

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.

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.