@article{1b6d0b361cbf4b409113e21c0d429131,
title = "Posttransplant Outcomes in Older Patients With Hepatocellular Carcinoma Are Driven by Non–Hepatocellular Carcinoma Factors",
abstract = "The incidence of hepatocellular carcinoma (HCC) is growing in the United States, especially among the elderly. Older patients are increasingly receiving transplants as a result of HCC, but the impact of advancing age on long-term posttransplant outcomes is not clear. To study this, we used data from the US Multicenter HCC Transplant Consortium of 4980 patients. We divided the patients into 4 groups by age at transplantation: 18 to 64 years (n = 4001), 65 to 69 years (n = 683), 70 to 74 years (n = 252), and ≥75 years (n = 44). There were no differences in HCC tumor stage, type of bridging locoregional therapy, or explant residual tumor between the groups. Older age was confirmed to be an independent and significant predictor of overall survival even after adjusting for demographic, etiologic, and cancer-related factors on multivariable analysis. A dose-response effect of age on survival was observed, with every 5-year increase in age older than 50 years resulting in an absolute increase of 8.3% in the mortality rate. Competing risk analysis revealed that older patients experienced higher rates of non–HCC-related mortality (P = 0.004), and not HCC-related death (P = 0.24). To delineate the precise cause of death, we further analyzed a single-center cohort of patients who received a transplant as a result of HCC (n = 302). Patients older than 65 years had a higher incidence of de novo cancer (18.1% versus 7.6%; P = 0.006) after transplantation and higher overall cancer-related mortality (14.3% versus 6.6%; P = 0.03). Even carefully selected elderly patients with HCC have significantly worse posttransplant survival rates, which are mostly driven by non–HCC-related causes. Minimizing immunosuppression and closer surveillance for de novo cancers can potentially improve the outcomes in elderly patients who received a transplant as a result of HCC.",
author = "Nia Adeniji and Vinodhini Arjunan and Vijay Prabhakar and Ajitha Mannalithara and Tara Ghaziani and Aijaz Ahmed and Paul Kwo and Mindie Nguyen and Melcher, {Marc L.} and Busuttil, {Ronald W.} and Florman, {Sander S.} and Brandy Haydel and Ruiz, {Richard M.} and Klintmalm, {Goran B.} and Lee, {David D.} and {Burcin Taner}, C. and Hoteit, {Maarouf A.} and Verna, {Elizabeth C.} and Halazun, {Karim J.} and Tevar, {Amit D.} and Abhinav Humar and Chapman, {William C.} and Neeta Vachharajani and Federico Aucejo and Nydam, {Trevor L.} and Markmann, {James F.} and Constance Mobley and Mark Ghobrial and Langnas, {Alan N.} and Carney, {Carol A.} and Jennifer Berumen and Schnickel, {Gabriel T.} and Sudan, {Debra L.} and Hong, {Johnny C.} and Abbas Rana and Jones, {Christopher M.} and Fishbein, {Thomas M.} and Vatche Agopian and Renumathy Dhanasekaran",
note = "Funding Information: Renumathy Dhanasekaran reports funding from National Institutes of Health Grant CA222676. American College of Gastroenterology Junior Faculty Career Development Award National Cancer Institute. Funding Information: Mindie Nguyen has received grants from BMS, Janssen Pharmaceuticals Gilead Sciences, NCI, and B.K. Kee Foundations; research support from BMS, Janssen Pharmaceuticals Gilead Sciences, Lab for Advanced Medicine, and Exact Sciences; and advises BMS, Janssen Pharmaceuticals Gilead Sciences, Lab for Advanced Medicine, Exact Sciences, Intercept Pharmaceuticals, Roche Laboratories, Dynavax Laboratory, Alnylam Pharmaceuticals, Novartis, Eisai, Bayer, and Spring Bank. Paul Kwo consults and has received grants from Eisai. Elizabeth C. Verna has received grants from Salix. William C. Chapman consults for Novartis Pharmaceuticals and has intellectual property rights with Pathfinder Therapeutics. Maarouf A. Hoteit advises HepQuant, LLC, and Eisai. Amit D. Tevar advises CSL Behring. Funding Information: Renumathy Dhanasekaran reports funding from National Institutes of Health Grant CA222676. American College of Gastroenterology Junior Faculty Career Development Award National Cancer Institute. Publisher Copyright: Copyright {\textcopyright} 2020 by the American Association for the Study of Liver Diseases.",
year = "2021",
month = may,
doi = "10.1002/lt.25974",
language = "English",
volume = "27",
pages = "684--698",
journal = "Liver Transplantation",
issn = "1527-6465",
number = "5",
}