Old wastewater treatment plants (WWTPs) must be upgraded to alleviate the problems associated with aging and reduce their total environmental impacts. To enhance the environmental sustainability in retrofitting large and old WWTPs, the decision-making process for selecting the most appropriate alternative is complicated. In this study, evaluation criteria were proposed to select the most sustainable alternatives for mid- to long-term retrofitting plans for a large WWTP with the treatment capacity of 1.6 M m3/d, which is initially built in 1987. An analytic hierarchy process was applied to estimate the weights of each criterion. Fourteen experts evaluated the relative importance of criteria through pairwise comparisons. In order to assess the current retrofitting opinions, three retrofitting alternatives were constructed: A focused on energy sufficiency; B expanded the bioreactor capacity and enhancement of the facility for incinerating the sludge leaving the anaerobic digestor; C emphasized the treatment of contaminants of emerging concerns (CECs). A achieved the highest score (0.623) owing to the environmental benefits associated with recycling and first flush stormwater treatment. C exhibited the second highest score (0.612) as the focus on CECs removal. B corresponded to the lowest sustainability (0.426), with the lowest scores pertaining to effective land use and first flush stormwater treatment.