Living Right Liver Donation from Donors Aged 45 and Older: Outcomes for Both Donors and Recipients.

This study evaluated the safety of living-donor liver transplantation (LDLT) using right lobe (RL) grafts from older donors (ODs; age ≥45 years) compared to younger donors (YDs; age <45 years). A total of 4,415 donor-recipient pairs were retrospectively analyzed, including ODs (N=238) and YDs (N=4,177). Donor complication rates, including overall (4.5% vs. 1.3%, p=0.01) and major (2.8% vs. 0.4%, p=0.02) complications were significantly lower in the OD group, indicating no increased surgical risk for ODs. However, recipients of OD group showed significantly higher incidence of biliary stricture (10.1% vs. 6.0%; p=0.01) and 1-year graft failure (11.3% vs. 5.5%; p<0.001), and poorer graft survival (5-year: 77.6% vs. 85.0%; p=0.004) compared with YD group. Furthermore, among patients with MELD scores ≥20, recipients of OD group showed significantly poorer graft survival (5-year: 68.5% vs. 82.2%; p=0.02). These outcomes remained consistent after propensity score matching. Multivariable Cox proportional hazards regression identified using OD grafts as a significant risk factor for recipient graft survival. LDLT using RL from ODs increased risks of biliary stricture and early graft failure in recipients, particularly in MELD scores ≥20, without compromising donor safety. Careful donor-recipient matching is critical when considering ODs in LDLT.