Outcomes of living-donor liver transplantation in older patients over 65 and 70 years compared to the younger recipients

Abstract

Background: As liver transplantation is increasingly considered for older adults with high perioperative risks, this study investigated the outcomes of living donor liver transplantation (LDLT) in older compared to younger recipients. Methods: A retrospective analysis was performed involving 908 LDLT recipients, categorized by age: <64 years (n = 862), 65-69 years (n = 80), and >= 70 years (n = 28). Graft survival and complications were compared between the age groups. Results: Older recipients (>= 65 years) exhibited a high incidence of preexisting conditions including hypertension and diabetes. Five-year graft survival was reduced in older recipients in unmatched analysis (81.8 % in <64 years vs. 75.0 % in 65-69 years vs. 69.7 % in >= 70 years, P = 0.045). However, this difference was not significant in multivariable Cox regression (hazard ratio [HR] 1.44, P = 0.156 for 65-69 years and HR 1.69, P = 0.156 for >= 70 years). In matched analyses, graft survival in the 65-69 age group (78.9 % vs. 74.5 %, P = 0.324) and the >= 70 age group (80.3 % vs. 76.0 %, P = 0.551) was not inferior to that of the <64 age group. Rejection and surgical complications within 1 year were similar between the groups. However, the incidence of pneumonia was significantly higher in the older group than that in the younger group (11.3 % vs. 20.8 % vs. 19.3 %, P = 0.019). Conclusion: LDLT in older patients demonstrated survival comparable to that in younger patients when pre-transplant characteristics were adjusted. Patient selection based on comorbidities and infection prevention strategies is critical for optimizing postoperative outcomes in this demographic group. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).