Elderly patients with Hepatocellular Carcinoma benefit from liver transplantation as much as younger ones

Abstract

Introduction: The literature on liver transplantation (LT) for cirrhosis-associated hepatocellular carcinoma (cirr-HCC) in elderly patients (≥65 years of age) is scarce. The aim of this study was therefore to analyze the outcome after LT for cirr HCC in elderly patients in our single-center experience. Methods: All consecutive patients who underwent LT for cirr-HCC at our center were identified from our prospective ly collected LT database and stratified into an elderly (≥65 years) and a younger (<65 years) cohort. Perioperative mor tality as well as Kaplan-Meier estimations of overall (OS) and recurrence-free survival (RFS) were compared between age strata. A subgroup analysis was performed for patients with HCC only inside Milan criteria. For further oncological com parison, outcome in the subgroup of elderly LT recipients with HCC inside Milan was also compared to a group of el derly patients undergoing liver resection for cirr-HCC inside Milan extracted from our institutional liver resection data base. Results: Out of 369 consecutive patients with cirr-HCC who underwent LT between 1998 and 2022 at our center, we identified 97 elderly (with a subgroup of 14 septuage narians) and 272 younger LT patients. 5- and 10-year OS in elderly compared to younger LT patients was 63% and 52% versus 63% and 46% (p = 0.67), respectively, while 5- and 10-year RFS was 58% and 49% versus 58% and 44% (p = 0.69). 5-/10-year OS and RFS in 50 elderly LT recipients with HCC inside Milan were 68%/55% and 62%/54%, re spectively, which compared to 46%/38% (p = 0.07) and 26%/14% (p < 0.0001) in elderly patients after liver resec tion for cirr-HCC inside Milan. Conclusion: Our results in al most 100 elderly patients after LT for cirr-HCC show that older age per se should not be considered a contraindica tion to LT and that selected elderly patients older than 65 and even 70 years benefit from LT as much as younger ones.