The purpose of this study was to determine the outcomes of living donor liver transplantation (LDLT) for elderly recipients. We reviewed 411 adult-to-adult LDLT cases, including 46 recipients who were 65 years old or older and 365 recipients who were less than 65 years old. The elderly group had a higher proportion of females (P=0.04) and a smaller body surface area (P<0.001) and more frequently underwent transplantation because of hepatitis C (P<0.001) or hepatocellular carcinoma (P<0.001). Elderly patients had less advanced liver disease with lower Model for End-Stage Liver Disease (MELD) scores (P=0.02) and preserved health without the need for prolonged hospitalization (P<0.01). The transplanted graft volume/standard liver volume ratios were similar for the 2 groups (P=0.22). The elderly group had fewer episodes of acute rejection (P=0.03) but had more neuropsychiatric complications (P=0.01). The 5- and 10-year graft survival rates were comparable for the elderly group (89.8% and 77.8%, respectively) and the younger group (79.4% and 72.9%, respectively; P=0.21). Seven recipients were 70 years old or older, and they had a mean MELD score of 15.6±5.2; 6 of these patients were treated as outpatients before LDLT. All were alive after LDLT and showed good compliance with medical management with a mean follow-up of 5.7±3.0 years. In conclusion, LDLT can be safely performed and has acceptable long-term outcomes for low-risk elderly recipients with preserved performance status.
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