Influence of Recipient Age on Outcomes After Liver Transplantation for Hepatocellular Carcinoma

Objectives: Liver transplantation (LT) is being performed with increasing frequency in elderly patients in parallel with the aging population worldwide today. In this study, we aimed to analyze the outcomes of LT for HCC in patients aged ≥65 (Older) versus those <65 (Younger).
Methods: In total of 535 HCC patients undergone LT at İnönü University Liver Transplantation Institute between April 2006 and March 2025 were retrospectively reviewed from a consecutively and prospectively recorded database and were analyzed. Results: 68 out of 535 LT’s age were ≥65 (12.7%). The percentage of older HCC patients receiving LT increased over time: it was 6.3% from 2002-2010, 11.3% from 2011-2020, and 17.5% from 2021-2025, showing a significant upward trend (p=0.039). 1-5-, and 10-years OS was 89.1%, 66.8%, and 53.9% in Younger group, and 81.5%, 52.8%, and 39.7% in Older group (p=0.012). Age≥65years was an independent predictor of mortality in patients undergoing LT for HCC (HR = 1.65, 95% CI: 1.11–2.46, p = 0.013). DFS, recurrence rate, tumor characteristics, demographics were similar. Only the last creatin level before LT (0.88 vs 0.8, p=0.003) and beyond Milan criteria rate were significantly higher (39.7% vs 60.2%, p=0.039) in the Older group.
Conclusion: Older age was independently associated with worse post-transplant overall survival among patients undergoing LT for HCC. This inferior survival cannot attribute to the tumor-related factors. Future studies focusing on sarcopenia, frailty, causes of death, and post-transplant complications, immunosuppressive regimens to better define the mechanisms underlying poor survival outcomes in elderly liver transplant recipients and to improve patient selection and post-transplant management in this growing population.

Keywords: Older, elderly, younger, hepatobiliary, neoplasm, survival, recurrence