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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.