Impact of donor–recipient age mismatching on liver transplantation outcomes

Results from an analysis of the Scientific Registry of Transplant Recipients (SRTR) database, evaluating the impact of donor–recipient age mismatching on outcomes following first-time, single-organ, donation after brain death (DBD) liver transplantation in the United States, were published in Transplantation by Elias et al. (N = 61,444). The primary endpoints were national trends in donor and recipient age, and unadjusted 5-year patient survival, graft survival, and death-censored graft survival across donor–recipient age groups. 

Key data: Mean donor age increased from 40.6 ± 18.2 years in 2011 to 42.0 ± 17.3 years in 2021, while mean recipient age increased from 51.1 ± 16.3 years to 51.7 ± 15.8 years (both p < 0.001). Five-year patient, graft, and death-censored graft survival declined with increasing donor age, most notably in younger recipients. In multivariable models, donor age >45 years was associated with increased mortality and graft failure in recipients ≤35 years, while outcomes among recipients ≥65 years were largely unaffected by donor age. Donor–recipient age interactions were significant across all outcomes (p < 0.001). 

Key learning: Donor–recipient age matching, rather than donor age alone, influences liver transplantation outcomes, particularly in younger recipients, supporting age-conscious allocation.