Outcomes of liver transplantation in patients 70 years or older: a systematic review and meta-analysis

The rate of liver transplantation is increasing among the elderly population; however, data is limited on the post-liver transplantation outcomes in patients ≥70 years. Given the scarcity in liver allograft resources, a meta-analysis on the outcomes of liver transplantation in patients ≥70 years is warranted.

Multiple databases were searched through March 2022 for studies that reported on the outcomes of liver-transplantation in patients ≥70 years. Meta-analysis was conducted using the random-effects model and heterogeneity was assessed using the I² statistics.

Ten studies were included that analyzed 162,725 patients. The pooled rate of 1-year, 3-years and 5-years post liver transplant survival for patients ≥70 years was 78.7% (72.6-83.7; I²=74%), 61.2% (52.3-69.5; I²=87%), and 48.9% (39.3-58.6; I²=96%), respectively. The corresponding 1-year, 3-years and 5-years survival for patients <70 years were 86.6% (82.4-89.9; I²=99%), 73.2% (63-81.3; I²=99%), and 70.1% (66.8-73.2; I²=99%); respectively. Descriptive p-values of comparison were statistically significant at 1-year and 5-years (p = 0.02 and <0.001). The pooled rate of perioperative complications in patients ≥70 years was 40.7% (26.2-57; I²=93%). The pooled rate of graft failure in patients ≥70 years was 6.7% (3.3-13.1; I²=93%) and in patients <70 years was 3.7% (1-12.4; I²=99%). The pooled rate of perioperative mortality in patients ≥70 years was 16.6% (7.6-32.5; I²=99%) and in patients <70 years was 0.8% (0-33.1; I²=88%).

Patients ≥70 years undergoing liver transplantation seem to demonstrate significantly lower 1-year and 5-year survival rates as compared to patients <70 years, albeit limited by heterogeneity.