Tailoring Liver Transplant Decisions: How Donor-Recipient Age Matching Influences Outcomes.

Area of Science:

• Transplantation research
• Organ transplantation outcomes
• Geriatric medicine in transplantation

Background:

• Donor age is a critical factor influencing liver transplant (LT) success.
• The precise impact of donor age varies significantly across different recipient age demographics.
• Specific donor age thresholds linked to increased post-transplant risk are not well-defined.

Purpose of the Study:

• To define recipient age-specific donor age thresholds associated with adverse post-liver transplant outcomes.
• To identify critical donor age cutoffs that increase mortality and graft loss risk within distinct recipient age strata.
• To inform organ allocation strategies by quantifying donor age risks relative to recipient age.

Main Methods:

• Analysis of first-time, single-organ liver transplant (LT) recipients from the Scientific Registry of Transplant Recipients (2011-2021).
• Stratification of donors and recipients by age groups to assess outcomes.
• Multivariable Cox regression models were employed to identify donor age thresholds associated with increased risk, adjusting for key covariates.

Main Results:

• Donor age ≥50 years significantly increased mortality risk (aHR, 6.48) in pediatric liver transplant recipients.
• For adult recipients aged 18.1-30 years, donors >55 years were linked to excess mortality and graft loss (aHRs >2.5).
• Risk escalated with increasing donor age in recipients aged 40.1-60 years, while donor age showed no significant outcome association in recipients ≥65 years.

Conclusions:

• This study establishes recipient age-specific donor age thresholds for post-liver transplant risk, a novel national finding.
• The identified thresholds support the creation of age-informed organ allocation policies.
• Reevaluation of organ discard practices is recommended given the rising ages of both donors and recipients in liver transplantation.