Risk Profiles and Outcomes in Living Donor Liver Transplantation Recipients Aged 70 y and Older: A Korean National...

As the global population ages, older-aged candidates increasingly undergo living donor liver transplantation (LDLT). Outcomes and risk factors in recipients aged ≥70 y remain unclear. This study assessed graft survival and age-specific risk factors using nationwide registry data.

From the Korean Organ Transplantation Registry, 4802 adult LDLT recipients were categorized into age <70 (n = 4660) and age ≥70 (n = 142) groups. Graft survival was analyzed using Kaplan-Meier and multivariable Cox regression to evaluate real-world outcomes. Propensity score matching was additionally performed as a sensitivity analysis to confirm the robustness of the findings. Subgroup analyses were used to identify risk factors specific to the age ≥70 group.

In unmatched analyses, recipients aged ≥70 y demonstrated significantly lower graft survival than younger recipients (5-y survival: 74.4% versus 87.2%; P  < 0.001). However, after multivariable adjustment, age ≥70 was not an independent predictor of graft loss (adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.83-1.87; P  = 0.29). Similar findings were observed in the propensity-matched cohort. Subgroup analyses demonstrated that, among recipients aged ≥70 y, pretransplant hospitalization (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.14-3.29), graft steatosis ≥5% (aHR, 1.74; 95% CI, 1.03-2.95), and vascular complications (aHR, 3.11; 95% CI, 1.31-7.43) were each associated with significantly elevated risk of graft failure.

Chronological age alone did not independently predict graft failure, but age ≥70 y may amplify risk when combined with steatosis, pretransplant hospitalization, or vascular complications. Therefore, LDLT eligibility in elderly candidates may be better guided by clinical risk profiling rather than age alone.