Differential aging trends among Liver Transplant candidates with and without hepatocellular carcinoma.

Background: Hepatocellular carcinoma (HCC) has become a leading indication for liver transplant (LT), with HCC registrants increasing more than six-fold in the past two decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older HCC patients are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger HCC patients, and non-HCC patients.

Methods: All adult LT candidates (18+) in the UNOS/OPTN registry (2012-2022) were analyzed, categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group.

Results: The aging trend among LT registrants was more pronounced in HCC patients. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among HCC patients decreased from 37.5% to 27.4%, while non-HCC patients dropped from 14.8% to 5%. Post-transplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older non-HCC patients (87% and 69%).

Conclusion: Among over 132,000 liver transplant registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older HCC patients.