Outcomes of living donor liver transplantation in elderly Egyptian patients: a retrospective study

Although the results of living donor liver transplantation (LDLT) in the elderly have been reported worldwide, there is still a dearth of information on elderly patients in Egypt. The purpose of this study is to investigate the clinical outcomes of LDLT in this growing population group.

This was a retrospective study that evaluated all LDLT patients at the Gastrointestinal Surgical Center, Mansoura University, from January 2009 to December 2023. Based on the recipient's age, two patient cohorts were created: younger (< 60) and elderly (≥ 60). Demographics, liver disease etiology, MELD score, surgical duration, blood loss, and early and late post-transplant outcomes (complications, graft survival, and patient survival) were compared between the two groups. Propensity score matching (PSM) was done to improve the baseline covariates imbalance.

Among 967 LDLT operations, 110 patients were classified in the elderly group (≥ 60 years). Hepatocellular carcinoma (HCC) was markedly more prevalent in the elderly group (44.6% vs. 30.5%, p = 0.002). After PSM analysis, the occurrence of early post-transplant problems was greater in the elderly group (65.5% vs. 51.9%, p = 0.033). Major complications were comparable between both groups (p = 0.763). Importantly, there was no statistically significant difference in 90-day mortality (p = 0.697) or in the 1, 3, and 5-year survival rates (p = 0.660) between the two matched groups.

Living donor liver transplantation for carefully selected elderly recipients yields comparable early survival outcomes to younger recipients. However, the elderly cohort faces a significantly higher risk of early morbidity and not statistically significant lower graft survival. Rigorous selection and targeted perioperative care are therefore essential.