Image of Zobair Younossi, M.D.; Image credit: Global NASH Council
Zobair Younossi, M.D.; Image credit: Global NASH Council

The number of older Americans needing liver transplants has skyrocketed, with some of the increase due to rising cases of nonalcoholic steatohepatitis (NASH), a fatty liver disease that can cause liver failure.

That’s according to investigators who studied trends among more than 31,000 liver transplant candidates, and presented their findings at an American Association for the Study of Liver Diseases conference this week. 

The percentage of transplant candidates aged 65 or older was 9% between 2002 and 200. That rose to 23% between 2018 and 2020, they found. Many of these candidates also had NASH, with cases of this condition increasing from 13% to 39% between the two study periods.

In contrast, the percentage of patients with hepatitis C virus, another leading cause of liver failure, dropped from 27% to 18% between the two study periods.

Age limit for transplantation can be arbitrary

When compared with younger transplant candidates in the study, older patients were less likely to get transplants and more likely to be removed from the list due to failing health. Their waitlist mortality rates, however, were similar to those of younger patients.

Older patients were more likely to receive a liver transplant when they were included in more recent waitlisting, were male, had a college degree, a higher MELD score — which measures the likelihood of surviving their disease over the next three months — or when they had a common type of liver cancer, the researchers found. 

Older patients who did not get a transplant were more likely to be Hispanic, be a Medicaid recipient or have pre-transplant type 2 diabetes.

This information and other data found in the study are needed to help clinicians and patients make transplant decisions as the population of patients with chronic liver diseases — especially NASH — get older, said Zobair Younossi, M.D., president of Inova Health System and the study’s senior investigator.

In the past, a liver transplant recipient’s age could not exceed 45 to 50 years. And although the age limit has increased over time, an arbitrary cutoff often remains. Older patients’ mortality is higher after transplantation than younger patients’, but they are now faring better post-transplant than in the past, the researchers said. 

“By studying the outcomes of liver transplantation in the elderly, we can provide evidence to support the expansion of the transplant candidate pool,” Younossi said. “In fact, we believe it is more about the physiologic age of the patient than their chronologic age.”