The average age of patients awaiting liver transplant (LT) in the United States is increasing. Previous research on the effect of age on post-LT outcomes has produced conflicting results.

The donor pool for LT remains limited and donor organs is a precious resource. Thus, avoiding futility of transplant is important.

The objective of this study was to identify factors associated with futility of LT in elderly patients, to help inform the decision whether or not to list elderly patients with liver disease for transplant. We also aimed to investigate relevant post-transplant outcomes in elderly patients.

This study included all patients above the age of 45 who underwent LT at our center over a ten-year period (2010-2020). Of these patients, 260 were 65 years of age or older. In the elderly cohort, several patient factors were analyzed to determine if they were associated with a “futile” outcome defined as death within 90 d after transplant. We also analyzed three different age groups for secondary outcomes such as hospital length of stay (LOS), intensive care unit LOS and discharge to facility.

Diastolic congestive heart failure (CHF) was independently associated with futility of LT after adjusting for potential confounders. Elderly LT recipients had higher one year mortality, longer hospital LOS and were more likely to be discharged to a facility.

Diastolic CHF may be a prognostic indicator for futility of LT in elderly patients. This comorbidity should be considered as part of the pre-LT evaluation.

Further research is needed with a larger sample size, perhaps including multiple centers to determine if there are any other patient comorbidities (or other factors such as functional status and primary cause of liver disease) are associated with futility of LT in elderly patients.