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Published on: September 30, 2021
Differential aging trends among candidates for liver transplant with and without HCC
Gabrielle Jutras1, Neil Mehta, Jennifer C Lai
1Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
Insights
The proportion of older adults (70+) seeking liver transplants for hepatocellular carcinoma (HCC) has significantly increased, while outcomes for these patients remain favorable. Enhanced frailty assessments are crucial for this aging HCC population.
Area of Science:
- Hepatology and Transplant Surgery
- Geriatric Medicine
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a primary driver for liver transplantation (LT).
- There's a notable increase in older candidates (70+) for LT, particularly those with HCC.
- Evolving hepatitis C (HCV) treatments necessitate updated data on aging HCC patients.
Purpose of the Study:
- To analyze age trends and clinical characteristics of HCC patients on the LT waiting list.
- To compare transplant outcomes between older (70+) and younger HCC patients, and non-HCC controls.
- To assess the impact of changing etiologies on older HCC candidates.
Main Methods:
- Analysis of adult LT candidates (18+) from the UNOS/OPTN registry (2012-2022).
- Categorization by HCC status and age (<70 or 70+).
- Regression analysis to compare HCC and non-HCC registrants/recipients by age group.
Main Results:
- The mean age of HCC registrants increased from 58.7 to 62.9 (2012-2022), with 70+ rising from 4.2% to 15.0%.
- Non-HCC registrants showed stable mean age (53) and a modest rise in 70+ (2.1% to 4.7%).
- HCV prevalence decreased in HCC patients (37.5% to 27.4%). Post-LT survival for older HCC recipients (1-year: 91%, 5-year: 71%) was comparable to older non-HCC patients.
Conclusions:
- The aging trend is more pronounced in LT candidates with HCC.
- Older HCC recipients experience favorable transplant outcomes.
- Demographic shifts highlight the need for improved frailty assessments in older HCC patients awaiting LT.
Abstract:
HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC. All adult candidates for LT (18+) in the UNOS/OPTN registry (2012-2022) were analyzed and categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in patients with HCC. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among patients with HCC decreased from 37.5% to 27.4%, while patients without HCC dropped from 14.8% to 5%. Posttransplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older patients without HCC (87% and 69%). Among over 132,000 LT registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older patients with HCC.
