Korean J Transplant.  2023 Nov;37(Suppl 1):S167. 10.4285/ATW2023.F-7511.

Increased risk of infections, renal dysfunction, and de novo malignancy in elderly liver transplant recipients on tacrolimus based immunosuppressive therapy: a propensity score-matched study from a single center

• Kim MJ
• Lee JY
• Yi NJ
• Choi Y
• Lee KW
• Suh KS
• Kim AJ
• Jo YH
• Cho YS

• KMID: 2551787
• DOI: http://doi.org/10.4285/ATW2023.F-7511

Abstract

Background
With the aging population, the number of organ transplants in elderly patients is on the rise. However, it is crucial to recognize that elderly patients often experience age-related decline in immune function and pharmacokinetic changes of immunosuppressive drugs. Despite these differences, elderly recipients are typically administered the same immunosuppressive therapy as young recipients. This study aimed to assess the incidence of rejection and adverse events in elderly liver transplant recipients.
Methods
This retrospective cohort study from a single center included elderly patients (65 years or order) and 1:2 propensity score matched nonelderly group (aged 19–64 years) on tacrolimus-based immunosuppressive therapy after liver transplantation from 2011 to 2018. We estimated the 3-year incidence of rejection and adverse events, which included infections, diabetes, hypertension, dyslipidemia, renal dysfunction, osteoporosis, and de novo malignancy and compared these rates with the nonelderly group. Additionally, we compared the exposure and the ratio of serum concentration to dosage (C/D ratio) of tacrolimus during the first year between the two groups.
Results
Among the 120 elderly patients, 11.7% experienced rejection, 70.0% had infections, 54.2% experienced renal dysfunction, 36.7% had dyslipidemia, 21.7% and 11.7% experienced diabetes and hypertension, respectively, 4.2% developed de novo malignancy, and 3.3% had osteoporosis within 3-years. Elderly patients had a 1.43-fold increased risk of infections (adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 1.08–1.88), 2.21-fold higher risk of renal dysfunction (aHR, 2.21; 95% CI, 1.59–3.07) and 14.44-fold higher risk of de novo malignancy (aHR, 14.44; 95% CI, 1.60–130.32) compared to the nonelderly group. However, there was no statistically significant difference in tacrolimus exposure and C/D ratio between two groups.
Conclusions
Elderly liver transplant recipients exhibited a higher risk of complications, particularly infections, renal dysfunction, and de novo malignancy compared to nonelderly patients. Therefore, it is essential to consider age-specific immunosuppressive therapy and implement careful monitoring for elderly transplant recipients.