Donor-recipient age mismatch and outcomes in liver transplantation: A scientific registry of transplant recipients database analysis

World J Transplant. 2025 Dec 18;15(4):108376. doi: 10.5500/wjt.v15.i4.108376.

ABSTRACT

BACKGROUND: Old donor allografts in liver transplantation (LT) account for 25% of all allografts, and their utilization is projected to increase with the aging general population. Older allografts are associated with higher rates of all-cause mortality and graft failure; however, there is limited literature exploring the specific phenotypic changes (e.g., functional status, cause-specific mortality) observed in different donor:recipient age pairs.

AIM: To investigate differences in functional impairment and cause-specific mortality between different donor:recipient age pairs.

METHODS: This was a retrospective analysis of LT patients from the Scientific Registry of Transplant Recipients from 2002 to 2022. Donors were categorized into younger age donors, ≤ 45-years (YAD), middle-aged donors, 46-69-years (MAD), and older age donors, ≥ 70-years (OAD). Recipients were categorized into younger age recipients, ≤ 55-years (YAR) and older age recipients, > 55-years (OAR) age recipients. Multivariate Fine-Gray competing risk and logistic regression analyses identified independent risk factors for cause-specific mortality and improvements in functional status, respectively.

RESULTS: Overall, 126185 patients were included in the analysis: YAD:YAR (32.7%), YAD:OAR (25.2%), MAD:YAR (17.5%), MAD:OAR (20.7%), OAD:YAR (1.3%), and OAD:OAR (2.7%). Compared to YAD:YAR, OAD pairs had the lowest likelihoods of improved functional status 5 years post-LT (OAD:YAR odds ratio 0.53, 95% confidence interval 0.42-0.67, P < 0.001; OAD:OAR odds ratio 0.67, 95% confidence interval 0.51-0.89, P = 0.006). Donor:recipient age pairs with older donors had higher rates of graft- and infection-related mortality compared to those with younger donors (P < 0.001). Meanwhile, donor:recipient age pairs with older recipients had higher cardioneurovascular- or malignancy-related deaths compared to those with younger recipients (P < 0.001).

CONCLUSION: Donor:recipient age mismatch was associated with differences in cause-specific mortality and functional status. These insights could potentially inform age-matched organ allocation strategies, though future work is warranted.

PMID:41357394 | PMC:PMC12679244 | DOI:10.5500/wjt.v15.i4.108376