Impact of Elderly Donors on Patient Survival and Postoperative Complications in Liver Transplantation: A Retrospective Study.

Background. Liver transplantation is the gold standard treatment for end-stage liver disease, yet approximately 23% of candidates die or are removed from the waitlist because of organ shortages. To expand the donor pool, elderly donors are increasingly used, but their impact on outcomes and postoperative complications remains controversial. Livers from elderly donors often show reduced regenerative capacity and diminished blood flow, which may increase posttransplant risks. Methods. We retrospectively analyzed 950 adult deceased-donor liver transplantations performed at Huashan Hospital between August 1, 2017, and November 30, 2023. Recipients were divided into an elderly donor group (≥60 y; n = 201) and a younger donor group (<60 y; n = 749). The study compared overall survival, disease-free survival for hepatocellular carcinoma, and various complications. Results. Overall survival (P = 0.681) and hepatocellular carcinoma disease-free survival (P = 0.486) were similar between groups. The elderly donor group had higher incidences of primary nonfunction (PNF; 4.0% versus 0.9%; P = 0.002), acute rejection (AR; 29.4% versus 10.9%; P = 0.001), and splenic artery steal syndrome (SASS; 2.0% versus 0.5%; P = 0.045). Retransplantation was numerically more frequent in the elderly donor group (4.0% versus 1.9%; P = 0.077). After adjustment, elderly donor status remained associated with PNF (odds ratio [OR], 3.199; 95% confidence interval [CI], 2.131-4.802), AR (OR, 5.314; 95% CI, 1.720-16.420), and SASS (OR, 5.881; 95% CI, 1.043-33.149), but not overall survival or retransplantation. Conclusions. Elderly donor grafts were not associated with inferior long-term recipient survival but were associated with higher risks of PNF, AR, and SASS.