Liver Transplantation Outcomes in Younger Versus Older Adult Recipients: The Edmonton Experience

Liver transplantation (LT) offers a lifesaving treatment for patients with end-stage liver disease (ESLD). There have been conflicting reports of outcomes in younger and elderly patients undergoing LT. This study assesses the outcomes of younger and elderly LT recipients by complications and graft survival at early and late time-points, up to 10 years.

This retrospective study was conducted on a prospectively collected database of patients who underwent LT between January 2011 and December 2021 at the University of Alberta Hospital in Edmonton, Canada.

A total of 696 patients who were 18 years and older were included and then classified into two groups: the younger adult group (YG; n = 631, < 65 years old) and the older adult group (OG; n = 65, > 65 years old). The YG was sicker, with a high model for ESLD (MELD) score, while the OG had a high incidence of coronary artery disease (CAD), hypertension, smoking, and hepatocellular carcinoma. The YG had a higher incidence of postoperative pleural effusion requiring drainage (108/631 [17%] versus 4/65 [6%]; p value < 0.02) and more rejection episodes (202/631 [32%] versus 10/65 [15%]; p value < 0.04). However, the OG had more hepatic artery thrombosis (HAT) (4/65 [6.1%] versus 10/631 [1.6%]; p value 0.03). CAD and smoking history were associated with lower patient and graft survivals; acute rejection episodes were also associated with significantly lower graft survival.

The patient and graft survival between the YG and OG are comparable at 30 days, 90 days, 1, 5 and 10 years. A history of CAD, smoking and rejection episodes decreased graft survival and age alone should not be a contraindication for LT.