Impact of Donor Age on Short-Term Outcomes After Pediatric Split Liver Transplantation

Split liver transplantation (SLT) expands access to grafts for pediatric recipients, but the short-term implications of donor age at the extremes of the accepted range remain uncertain.

We retrospectively analyzed 144 pediatric SLT recipients treated from 2015 to 2025. Recipients were grouped by donor age: 2-10 years (n = 21), 11-49 years (n = 103), and 50-63 years (n = 20). One-year patient and death-censored graft survival were assessed using Kaplan-Meier methods. Donor age was additionally modeled continuously per 10-year increase in separate Cox models for death-censored graft loss and patient death. The functional form of donor age for graft loss was examined using restricted cubic splines, and outcomes were explored by in situ versus ex situ splitting.

One-year patient survival was 90.5%, 91.2%, and 84.4% in Groups A, B, and C, respectively (log-rank p = 0.711); corresponding death-censored graft survival was 95.2%, 94.0%, and 84.1% (p = 0.334). Per 10-year increase in donor age, the hazard ratio was 1.217 (95% CI, 0.823-1.800; p = 0.324) for graft loss and 1.099 (95% CI, 0.796-1.516; p = 0.568) for patient death. No significant departure from linearity was detected (p for nonlinearity = 0.527). In situ and ex situ splitting showed no significant differences in 1-year survival after adjustment for donor age.

One-year survival did not differ significantly by donor age. Carefully selected young and older donors may be considered in experienced centers, although limited sample sizes and wide confidence intervals warrant caution.