Transplantation remains the standard of care for patients with liver cancer, regardless of age
Doctors and researchers from the Transplant Center at UK HealthCare and the Markey Cancer Center at the University of Kentucky conducted a study of patients over the age of 70 with a type of liver cancer called hepatocellular carcinoma (HCC) and on the comparison of the results of ablative treatments with liver transplants. The results were published in the May 2022 issue of the Journal of the American College of Surgeons.
Hepatocellular carcinoma is a cancer that starts in the liver, most often as part of cirrhosis, and when caught early enough can be treated with different therapies. The optimal therapy for these early-stage HCCs is liver transplantation. Unfortunately, the need for donated livers far exceeds the demand.
There are far more people in need of liver transplants than there are organs available. Transplant physicians have struggled for years to determine the best use of a scarce resource.”
Malay Shah, MD, Surgical Director of the Liver Transplant Program at UK HealthCare
Many factors are considered when a given patient is considered for a liver transplant. Surgical outcome data showed that older patients have poorer overall outcomes than younger patients. This is due, in part, to pre-existing health conditions in elderly patients. Specifically, transplants are invasive and complicated procedures that require extensive post-surgical care and follow-up. The risk of complications is high and the elderly are particularly susceptible. As a result, fewer elderly patients with HCC are considered candidates for transplant.
“Too often I hear patients say ‘I’m too old for a transplant,'” Shah said. “This study shows that in selected patients, transplantation is an acceptable option that has a significant survival advantage over ablation therapy alone. And as more physicians learn of these results, they will be able to help guide and educate their patients.”
Ablation is a minimally invasive procedure that kills or slows the growth of a tumor. If ablation can provide a similar survival benefit to transplantation in older patients with HCC, it might be a better, less invasive treatment for them instead of transplantation. This would allow transplant centers to use scarce donor livers in other patients who have no other alternative to transplantation. Conversely, if older patients have good outcomes after transplantation compared to ablation therapy alone, they should always be considered for transplantation, and age should not be considered.
“HCC is one of the main indications for liver transplantation, and many therapies are used to treat these cancers while the patient is waiting for a transplant,” Shah said. “Therapies such as ablation are done to prevent disease progression while waiting for the transplant. The technology and effectiveness of these therapies have improved dramatically in recent years.”
During the study period, 214 patients aged 70 years or older with stage I or II HCC who received liver transplantation were identified and compared to 2,377 patients in the same age group who received ablation as the destination treatment.
“This was the first direct comparison of outcomes of liver transplantation versus no transplantation for HCC in elderly patients,” Shah said. “What we found was that patients over the age of 70 still had a very significant survival advantage over ablative therapy alone and that transplantation should still be offered to appropriate elderly patients. Transplantation liver disease remains the standard of care for patients with HCC, regardless of age.”
More than 12,000 people in the United States are on the waiting list for liver transplants. To help alleviate the organ shortage and give others a second chance at life, register to become an organ donor today at https://registermeky.org/.
Shah, MB, et al. (2022) Outcomes in elderly patients undergoing liver transplantation compared with liver-directed ablative therapy in early-stage hepatocellular carcinoma. Journal of the American College of Surgeons. doi.org/10.1097/XCS.0000000000000135.