Living Donor Liver transplant in patients who are 60 years or older: Experience from a large volume centre in India

Abstract Background With ageing population and higher prevalence of NASH and HCC in older patients, more and more LDLT are being considered in this group of patients as eligibility for DDLT is restricted to those who are younger than 65 years of age. However the short and long term outcomes of this group has not been reported from India which does not have a robust National Health Scheme. The aim of this study was to provide guidelines for transplant in this group. Methods All patients older than 60 years of age (Group 1) who underwent living donor liver transplant in our centre between January 2006 to December 2017 were studied. A propensity score matched group in 1:2 ratio was created with comparable sex and MELD score (Group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1,3 & 5 year survival. Results Group I consisted of 207 patients and Group 2 had 414 patients. The number of patients in Group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC and they had a higher 30 day mortality due to cardiorespiratory complications. Although 1 and 3 year survival was similar, the 5 year survival was significantly lower in Group 1. Conclusion Five year survival was lower in elderly group due to cardiorespiratory complications and recurrence of HCC. Outcome in elderly group can be improved with better patient selection and preventing HCC recurrence.