Favorable outcomes in patients over 65 years of age with hepatocellular carcinoma undergoing liver transplantation

Background: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality worldwide. With the aging population, more people above the age of 65 may become liver transplant (LT) candidates. This study aims to evaluate the outcomes of LT in patients over 65 years of age with HCC. Methods: Using our electronic medical record system, we collected data of patients, who underwent LT, from January 2001 to December 2022, at our hospital. We included patients who underwent LT and had HCC. Results: Two hundred and forty-four patients with HCC were included in the study with a mean age of 59 (SD 9) years; 74 (30%) were female. The maximum diameter of HCC was 28 mm (SD 15). The median time between HCC diagnosis and LT was 226 (IQR 79-435) days. In total, 178 (73%) patients were 65 years or less, while 66 (27%) were above 65 years. Majority of patients had LDLT (74%). Incidental HCC was found in 19 (8%) patients. 58 (24%) were out of the Milan Criteria. A total of 129 (53%) received treatment for HCC prior to the transplant. The most common pre-transplant treatment was RFA in 59 patients (45%), followed by TACE in 37 (28%) patients. The in-hospital mortality rate was 5%. The Comprehensive Complication Index™ (CCI™) was 22.6 (IQR 8.7-39.7). The overall survival rates at 1, 2, 3, and 5 years were 92%, 88%, 86%, and 89%, respectively. Conclusion: Although lower than younger recipients, patients older than 65 years of age with HCC have an excellent outcome post-LT. Age alone should not discourage transplant centers from considering patients with HCC for transplantation.