LIVER TRANSPLANTATION IN OLDER PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE: AN ANALYSIS OF UNOS REGISTRY

Background: Acute on chronic liver failure (ACLF) patients undergoing liver transplantation (LT) may require additional consideration in selection and management due to their severity of illness. We hypothesized that older recipient age might increase the risk of graft loss in ACLF patients. We aimed to identify risk factors for post-transplant mortality in patients with ACLF, focusing on recipient age. Methods: Using data from the UNOS registry, this study evaluated adult liver or liver and kidney transplant recipients between 2014 and 2019. Patients with status 1A, multi-organ, hepatocellular carcinoma, and re-transplant were excluded. We identified patients with ACLF using European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria. One- year graft survival was compared between ACLF patients (ACLF grades 1, 2, 3) and those without ACLF for each age group (age\u3c50 \u3e[younger], 50-64 [mid], ≥65 [older]). Risk factors for 1-year graft survival were analyzed in ACLF patients using Cox regression models. A subgroup analysis in older ACLF patients was performed based on identified risk factors. Risk was adjusted by donor and recipient characteristics at LT. Results: Among 17,148 patients eligible for the study, 3,836 (22.4%), 3,050 (17.8%) and 2,084 (12.2%) had ACLF 1,2 and 3. 2983 (17.4%) patients were in the older group. In all age groups, ACLF 1, 2 and 3 groups showed significantly higher risk of 1-year graft loss than those without ACLF (Figure). In patients with ACLF, older recipient (≥65 years, aHR 1.56, P8 hours (aHR 1.21, P=0.038), and older donor (\u3e50 years: aHR 1.395, P Conclusion: Liver transplant outcomes were significantly worse in patients with ACLF compared to those without ACLF regardless of recipient age. Donor selection and shortening cold ischemia time may mitigate risk of graft loss in older patients with ACLF