S2879 Increase in Mortality and Allograft Rejection Post-Liver Transplant in a Cohort Between 50-90 Years Old

Introduction: The proportion of the global population between 2015-2020 older than 60 years is predicted to nearly double from 12% to 22%. With an aging population, there has been a concomitant rise in the age of liver transplant (LT) recipients. Recipients aged 65 and older, are the fastest-growing cohort among new liver transplant registrants, surpassing the 35–49 age group over the past decade. There is an increasing need to understand post-operative outcomes in older patients who are at increased risk for frailty and with more comorbidities than their younger counterparts. This study aims to report clinical outcomes in a cohort of LT recipients aged 50 years and older. Methods: This was a case series including 603 liver transplant recipients aged 50 years and older between 2016 and 2023. Non-identifiable information within the electronic health records (EHR) at academic hospital center was used. International Review Board approval was not required. ICD-9 Codes were utilized for data gathering from the database. EHR were mapped to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) version 5.3 such that standardized vocabularies like International Classification for Diseases (ICD) could be used to search for keywords. Comorbidity scores were calculated using the Charlson Comorbidity score. Results: The study included 211 (35%) women with a mean age of 61.8 years. 43.3% of the cohort were White and 41.1% were Hispanic. The most common etiology of liver disease was alcohol (64.18%). The mean Charlson comorbidity index was 9.1, indicating severe comorbidity. 6.3% died within one year post LT increasing to 8.5% 2 years post LT. 22.2% of patients had LT rejection within one year post LT which increased to 24.7% 2 years post LT. Conclusion: In this study of adults >50 years of age, there was a significant increase in mortality and rejection over time. These findings can be explained by graft rejection, infection and LT related complications over time. Although future prospective studies are needed to elucidate the underlying mechanisms, this study underscores the importance of studying LT outcomes in an older cohort of patients.