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Propensity Score Matched Analysis of Post-Transplant Outcomes in Living Donor Liver Transplantation for Older Adult Recipients.

Research paper by Abdul Rahman AR Hakeem, Rukhaiya R Fathima, Hrishikesh H Padmanaban, Kulaseharan K Haribabu, Rajesh R Rajalingam, Kumar K Palaniappan, Dinesh D Jothimani, Rathan R Kanagavelu, Akila A Rajakumar, Ilankumaran I Kaliamoorthy, Mettu Srinivas MS Reddy, Mohamed M Rela

Indexed on: 01 Apr '21Published on: 01 Apr '21Published in: Liver Transplantation



Abstract

The impact of increasing recipient age on morbidity and mortality following living donor liver transplant (LDLT) remains controversial. The study aims to analyse the impact of recipient age on outcomes following LDLT. Adult LDLTs performed between November 2009 to February 2020 were retrieved from a prospectively maintained database. Patients were stratified into two groups based on recipient age: 18-65 years (younger adults) and >65 years (older adults). Propensity score matching (PSM) using nearest-neighbour matching was used to match each older recipient with upto two younger adult recipients using multiple pre-operative parameters. Outcomes evaluated were duration of ventilation, need for reintubation, tracheostomy, intensive care unit (ICU) readmission, length of ICU and hospital stay, post-operative complications, re-operation within 90 days, and patient survival. A total of 801 adult LDLT recipients were included in the study - 751 (93.7%) were younger adults and 50 (6.3%) were older adults. Older recipients were more likely to be diabetic (60.0% vs. 39.7%), hypertensive (44.0% vs. 20.4%), with pre-existing cardiac disease (28.0% vs. 11.2%). However, their pre-transplant MELD was significantly lower (14.5 vs. 17.7) and they were more likely to be transplanted for HCC (38.0% vs. 17.7%). Older recipients had longer duration of ventilation post-LT both before (3.7 vs. 1.9 days) and after PSM (4.0 vs. 1.5 days). After PSM, the 30-day (13.0% vs. 2.4%), 90-day (15.2% and 2.4%) and overall mortality (21.7% vs. 7.1%) was significantly higher for older recipients, when compared to younger recipients. There was no difference between the younger and older recipients, with respect to other post-operative outcomes. This propensity score matched study shows that the older LDLT recipients have higher 30-day, 90-day and 1- and 5-year mortality, when compared to matched younger counterparts. This article is protected by copyright. All rights reserved.

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