*Purpose: Previous data has shown elderly liver transplant recipients (LTx) to be at a lower risk of acute rejection than younger recipients. As such, elderly recipients may benefit from reduced immunosuppression (IS) exposure to minimize infectious and malignant complications without a corresponding impact on rejection. The objective of this analysis is to evaluate outcomes in LTx recipients 60 years and older compared to a younger cohort 18 – 59 years maintained on a similar level of IS.

*Methods: This was a single-center retrospective evaluation of adult LTx recipients from 2015-2018 who received methylprednisolone induction and were maintained on tacrolimus, mycophenolate mofetil (MMF), and a prednisone taper. Patients with multi-organ transplant, history of prior LTx, HIV, autoimmune liver disease as indication for LTx, or use of alternative IS were excluded. First episode of empiric or biopsy proven acute rejection within 1 year post-LTx was evaluated, as well as the incidence of death, infection, and malignancy.

*Results: A total of 107 LTx recipients were evaluated. Mean age in the older cohort was 65 ± 3.8 compared to 52 ± 8.3 years in the younger group (p&lt0.01). The majority of LTx were from DBD donors (68.2%). Mean tacrolimus levels at various time points and the duration of MMF and steroids were similar between groups. Incidence of first rejection within 1 year was similar between groups (21.3% vs. 21.7%, p=0.14), with no difference in patient survival, infection, or malignancy.

*Conclusions: In LTx recipients maintained on tacrolimus, MMF, and steroids, no difference in first episode of rejection within 1 year was observed in patients 60 years and older compared to a younger cohort 18 – 59 years. Rates of survival, infection, and malignancy were similar. Evaluation of additional patients may provide further insight into the study outcomes.

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