Survival after liver transplant in recipients of different age groups: a systematic review and meta-analysis

Abstract

Background and Aims: An increasing number of elderly patients are undergoing liver transplantation for end-stage liver disease and hepatocellular carcinoma. However, there is a paucity of data on the risk of mortality post-liver transplantation with respect to increasing age. Method: We performed a systematic review and meta-analysis to assess the effect of older age on mortality after liver transplantation. A comprehensive literature review was conducted utilizing the PUBMED, MEDLINE, SCOPUS and EMBASE databases through July 2019 to identify all cohort studies that compared the long-term survival outcome between patients who underwent liver transplantation at the age of older recipients versus younger recipients. Effect estimates from each study were extracted and combined using the random-effect. Results: Of 686 potentially eligible articles, a total of 20 studies with 19,412 participants fulfilled the eligibility criteria and were included in the meta-analysis. With respect to transplant mortality, subgroup analysis showed age ≥70 years compared to younger recipients had the pooled RR of 1.62 (95% CI, 1.49–1.77, p < 0.0001) (Figure); age ≥60 years compared to younger recipients had the pooled RR of 1.18 (95% CI, 0.96–1.44, p = 0.11) and age ≥50 years compared to younger recipients had the pooled RR of 1.44 (95% CI, 1.07–1.96, =0.02) (Figure). Between-group comparisons, recipients age ≥70 years were significantly increase risk of mortality post-liver transplantation ( p = 0.01). Conclusion: There was a significantly increased risk of mortality post-liver transplantation among recipients age ≥70 years. This suggests that the age of 70 years could be the deflection point where the rate of mortality starts to accelerate, with risks outweighing benefits beyond this age group.