Risk Profiles and Outcomes in Living Donor Liver Transplantation Recipients Aged 70 y and Older: A Korean National Registry Analysis

초록

BACKGROUND: As the global population ages, older-aged candidates increasingly undergo living donor liver transplantation (LDLT). Outcomes and risk factors in recipients aged &#x2265;70 y remain unclear. This study assessed graft survival and age-specific risk factors using nationwide registry data. METHODS: From the Korean Organ Transplantation Registry, 4802 adult LDLT recipients were categorized into age and age groups. Graft survival was analyzed using Kaplan-Meier and multivariable Cox regression to evaluate real-world outcomes. Propensity score matching was additionally performed as a sensitivity analysis to confirm the robustness of the findings. Subgroup analyses were used to identify risk factors specific to the age group. RESULTS: In unmatched analyses, recipients aged &#x2265;70 y demonstrated significantly lower graft survival than younger recipients (5-y survival: 74.4% versus 87.2%; P &#x2005;<&#x2005;0.001). However, after multivariable adjustment, age was not an independent predictor of graft loss (adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.83-1.87; P &#x2005;=&#x2005;0.29). Similar findings were observed in the propensity-matched cohort. Subgroup analyses demonstrated that, among recipients aged &#x2265;70 y, pretransplant hospitalization (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.14-3.29), graft steatosis (aHR, 1.74; 95% CI, 1.03-2.95), and vascular complications (aHR, 3.11; 95% CI, 1.31-7.43) were each associated with significantly elevated risk of graft failure. CONCLUSIONS: Chronological age alone did not independently predict graft failure, but age &#x2265;70 y may amplify risk when combined with steatosis, pretransplant hospitalization, or vascular complications. Therefore, LDLT eligibility in elderly candidates may be better guided by clinical risk profiling rather than age alone. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.