With increased demand for liver transplantation (LT), outcomes of older recipients have been subjected to greater scrutiny, as previous studies have demonstrated poorer survival outcomes. Outcomes of 77 patients aged ΟΎ 65 yr (group 1) who underwent transplantation between 1988 and 2003 at King's College Hospital, London, were compared with all recipients aged between 60 and 64 yr (group 2, n Ο 137) and 202 time-matched control patients with chronic liver disease aged between 18-59 yr (group 3). Patient survival at 30-days for groups 1, 2, and 3 were 99%, 94%, and 94%, respectively (P Ο not significant [NS]). At 1-yr, survival in the 3 groups was 82%, 86%, and 83%, respectively (P Ο NS), and at 5-yr patient survival was comparable (73%, 80%, and 78%, respectively) (P Ο NS). Episodes of acute cellular rejection (ACR) were fewer in the older cohorts (43% vs. 45% vs. 61%, P Ο 0.0016), although there was no significant difference identified in the numbers of patients in each group who experienced ACR (P Ο 0.16). A similar but nonsignificant trend was identified for rates of chronic rejection among the groups. In conclusion, these data suggest that survival of patients over 60 and 65 yr undergoing LT is satisfactory, at least in the first 5-yr posttransplantation. In addition, patients over 65 yr experience less rejection, with good graft survival. Thus, LT should not be denied to patients ΟΎ65 yr on the basis of age alone, once a comprehensive screen for comorbidity has been undertaken.