Background: Due to increased aged population, the number of the worlds people older than 60 years will rise to 2 billion in 2050 and improved health of this group (Life expectancy at age 65 and 75 year old increased from 16.4 and 10.4 in 1980 to 19.1 and 12.1 in 2010), surgeons are carrying out surgical procedures on more and more elderly patients including solid organ transplantation.  In the field of liver transplantation, demand of grafts for elderly increases.
Methods: Data from all consecutive liver transplantation patients from January 1990 to December 2016 were collected from a dedicated monocentric database. The present retrospective study relies on data prospectively collected and updated. Patients who underwent auxiliary liver transplantation were excluded. Two cohorts of patients further subdivided into elderly and young groups were studied:  First cohort included all liver transplant recipient between 18-65 vs >65 years old and the second cohort included liver transplant recipient between 50-65  vs > 65 years old. Overall survival (OS) and graft survival (GS) were explored in both comparative groups. Young liver transplant recipients were compared to elderly, after using a propensity score matching (PSM) method. The propensity score for an individual was calculated given the covariates of donor age and gender, cause of donor death ICU donor stay (days), recipient gender, recipient medical condition, indication for liver transplantation, child and cardiovascular risk factors. A 1:1 nearest neighbor matching was performed without replacement to minimize conditional bias. For each liver transplant performed in young group, a patient in elderly group with a minimum tested in distance of propensity score was matched. 
Results: Among 1126 patients, multiple caliper widths were tested. A caliper width of 0.01 resulted in the best trade-off between homogeneity and retained sample size. In the first cohort, after PSM, 208 patients were matched and an association between recipient age and graft and patient survival was found (p = 0.010). Regarding long-term outcomes analysis in the second cohort (n = 206), 5 and 10-year OS rates were 63% and 52% vs 64% and 45% (p = 0. 50) in young vs elderly recipients, respectively.  Five and 10-year GS rates were 62% and 52% vs 62% and 44% (p = 0.50 ) in young vs elderly recipients, respectively.  (p = 0.42).
Conclusions: Elderly age has an impact on long-term outcomes in liver transplant. Advanced age alone should not exclude a patient from LT but a meticulous preoperative evaluation and careful follow-up is imperative.