Perspective from Jamile’ Wakim-Fleming, MD
Disclosures: Younossi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
March 09, 2022
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NASH linked to sharp increase in liver transplants in older patients

Perspective from Jamile’ Wakim-Fleming, MD
Disclosures: Younossi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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As liver transplants significantly increase among older patients, nonalcoholic steatohepatitis has become the most common reason for the procedure in this population, according to a study published in Hepatology Communications.

“Another study from our team, which in publication in Clinical Gastroenterology and Hepatology, suggests that the proportion of elderly patients in need of liver transplantation in the U.S. is sharply increasing,” study author Zobair M. Younossi MD, MPH, president of Inova Medicine Services and professor and chairman of the department of medicine at Inova Fairfax Medical Campus in Virginia, told Healio. “At present, NASH is the most common indication for liver transplantation among the elderly. The outcomes of these patients have been improving in the past two decades so that three in four [patients] can expect to live at least 5 years posttransplant.”
Registry of Transplant Recipients to identify 31,209 LT candidates, aged 65 years or older, to evaluate on-list and posttransplant outcomes. Among the common etiologies were NASH (31%), hepatitis C (23%) and alcohol liver disease (18%). In addition, 30% of candidates had hepatocellular carcinoma.

infographic on NASH rates increasing in older patients

According to researchers, the proportion of adult LT candidates 65 years and older significantly increased (P < .0001) from 9% (2002-2005) to 23% (2018-2020); similarly, the proportion of NASH among older patients increased from 13% to 39% during those study periods. Of those, 54% underwent LT.

Results from multivariate analysis indicated that more recent years of listing, older age, male sex, higher Model for End-Stage Liver Disease (MELD) score and HCC (all P < .01) were independent predictors of an increased chance for receiving a transplant in patients 65 years and older.

In addition, posttransplant mortality was higher in older patients compared with younger LT recipients; however, this mortality rate decreased over time. Independent predictors of higher posttransplant mortality in older LT recipients included earlier years of transplantation, older age, male sex, higher MELD score, history of type 2 diabetes, retransplantation and HCC at baseline or follow-up (all P < .01).

“We found that elderly patients in need of a liver transplant are increasingly being considered for the procedure,” Younossi and colleagues concluded. “Further research is

needed to improve both on-list and posttransplant management of patients of advanced age in order to meet the growing demand for this complex treatment among the aging population with liver disease.”