Impact of elderly donors on the survival and complications in liver transplantation

Background Despite increased use, the impact of elder donors on the outcomes of liver transplantation remains controversial, particularly with regard to postoperative complications. Methods Retrospective data of adult liver transplantation with deceased donors between August 1, 2017 to November 30, 2023 were collected. The aim was to compare survival as well as postoperative complications of the recipients with elderly donors (≥ 60 years) to younger donors (< 60 years). Results Out of a total of 950 liver transplants, 201 were elderly donors and 749 were younger donors. No difference in overall survival or disease-free survival in patients with hepatocellular carcinoma between the two groups was demonstrated. Elderly donors were associated with higher incidence of primary nonfunction, re-transplantation, acute rejection, and splenic artery steal syndrome. No difference in biliary complications was observed. Conclusions Elderly donors do not affect patient survival, despite the higher incidence of PNF and re-transplantation. But elder grafts are more susceptible to acute rejection and splenic artery steal syndrome. Additional interventions should be taken to prevent these complications with elderly donors.