Living right liver donation from donors aged 45 years and older: Outcomes for both donors and recipients

This study evaluated the safety of living-donor liver transplantation (LDLT) using right lobe grafts from older donors (ODs; aged ≥45 years) compared to younger donors (YDs; aged <45 years). A total of 4415 donor-recipient pairs were retrospectively analyzed, including ODs (N = 238) and YDs (N = 4177). Donor complication rates, including overall (4.5% vs 1.3%, P = .01) and major (2.8% vs 0.4%, P = .02) complications, were significantly lower in the OD group, indicating no increased surgical risk for ODs. However, recipients of the OD group showed significantly higher incidence of biliary stricture (10.1% vs 6.0%; P = .01) and 1-year graft failure (11.3% vs 5.5%; P < .001), and poorer graft survival (GS) (5-year: 77.6% vs 85.0%; P = .004) compared with the YD group. Furthermore, among patients with model for end-stage liver disease scores ≥20, recipients of the OD group showed significantly poorer GS (5-year: 68.5% vs 82.2%; P = .02). These outcomes remained consistent after propensity score matching. Multivariable Cox proportional hazards regression identified the use of OD grafts as a significant risk factor for recipient GS. LDLT using right lobe grafts from ODs increased risks of biliary stricture and early graft failure in recipients, particularly in model for end-stage liver disease scores ≥20, without compromising donor safety. Careful donor-recipient matching is critical when considering ODs in LDLT.