Impact of Advanced Age on Outcomes of Live Donor Liver Transplantation: A Retrospective Cohort Study in Recipients Aged ≥65 Years.

BACKGROUND Advanced age has traditionally been considered a relative contraindication for liver transplantation (LT) owing to increased perioperative risk and comorbid burden. However, recent evidence suggests that appropriately selected elderly patients can achieve comparable outcomes to younger recipients.

OBJECTIVE To evaluate and compare perioperative outcomes, comorbidities, and survival in live donor liver transplantation (LDLT) recipients aged ≥65 years versus <65 years METHODS: This retrospective observational study analyzed adult LDLT recipients at a high-volume transplant center between November 2019 and June 2024. Patients were divided into 2 groups based on age at transplantation: <65 years (n = 182) and ≥65 years (n = 43). Demographic data, MELD scores, comorbidities, perioperative complications, and survival rates were compared. Cox regression analysis was used to identify independent predictors of mortality.

RESULTS The elderly group had significantly lower MELD scores (15.1 vs. 17.2, p = .02) but higher rates of cardiovascular comorbidity (39.5% vs. 26.4%, p = .018). No significant differences were observed in diabetes prevalence, pulmonary disease, length of hospital stay, or early and late complication rates. One-year survival rates were 83.7% for elderly and 88.7% for younger recipients. Although the mortality risk was higher in the elderly group (HR = 2.13, p = .064), the difference was not statistically significant.

CONCLUSION Advanced age alone should not be considered a contraindication for LDLT. With appropriate candidate selection and individualized perioperative management, elderly recipients can achieve favorable outcomes comparable to younger patients.