Liver transplantation for elderly patients with early-stage hepatocellular carcinoma

Yutaka Endo; Kazunari Sasaki; Zorays Moazzam; Henrique A Lima; Laura Alaimo; Muhammad Musaab Munir; Chanza F Shaikh; Austin Schenk; Minoru Kitago; Timothy M Pawlik

doi:10.1093/bjs/znad243

Liver transplantation for elderly patients with early-stage hepatocellular carcinoma

Br J Surg. 2023 Oct 10;110(11):1527-1534. doi: 10.1093/bjs/znad243.

Affiliations

¹ Department of Surgery, Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
² Department of Surgery, Stanford University, Stanford, California, USA.
³ Department of Surgery, Keio University, Tokyo, Japan.

PMID: 37548041
DOI: 10.1093/bjs/znad243

Abstract

Background: Although liver resection is a viable option for patients with early-stage hepatocellular carcinoma (HCC), liver transplantation is the optimal treatment. The aim of this study was to identify characteristics of liver transplantation for elderly patients, and to assess the therapeutic benefit derived from liver transplantation over liver resection.

Methods: This was a population-based study of patients undergoing liver transplantation for HCC in the USA between 2004 and 2018. Data were retrieved from the National Cancer Database. Elderly patients were defined as individuals aged 70 years and over. Propensity score overlap weighting was used to control for heterogeneity between the liver resection and liver transplantation cohorts.

Results: Among 4909 liver transplant recipients, 215 patients (4.1 per cent) were classified as elderly. Among 5922 patients who underwent liver resection, 1907 (32.2 per cent) were elderly. Elderly patients who underwent liver transplantation did not have a higher hazard of dying during the first 5 years after transplantation than non-elderly recipients. After propensity score weighting, liver transplantation was associated with a lower risk of death than liver resection. Other factors associated with overall survival included diagnosis during 2016-2018, non-white/non-African American race, and α-fetoprotein level over 20 ng/dl.

Conclusion: Elderly patients with HCC should not be excluded from liver transplantation based on age only. Transplantation leads to favourable survival compared with liver resection.