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

doi:10.5500/wjt.v15.i4.108376

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

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

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

Bima J Hasjim, Shi-Yi Chen, Naomi KT Hlaing, Hirohito Ichii, Robert R Redfield, David K Imagawa, Mamatha Bhat

Bima J Hasjim, Hirohito Ichii, Robert R Redfield, David K Imagawa, Department of Surgery, UC Irvine, Orange, CA 92868, United States

Shi-Yi Chen, Department of Biostatistics, University of Toronto, Toronto M5G 1L7, Ontario, Canada

Naomi KT Hlaing, Mamatha Bhat, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto M5G 2N2, Ontario, Canada

Author contributions: Hasjim BJ, Chen SY, and Bhat M participated in the concept, design of the study, provided administrative, technical, or material support; Hasjim BJ, Chen SY, Hlaing NKT, Ichii H, Redfield RR, Imagawa DK, and Bhat M assisted in the acquisition, analysis, or interpretation of data, and provided critical revision of the manuscript for important intellectual content; Hasjim BJ and Chen SY drafted the manuscript; Chen SY conducted the statistical analysis; Bhat M supervised the project; and all authors approved the final version of the manuscript that was submitted.

Institutional review board statement: This study was approved by the Medical Ethics Committee of University of California, approval No. #4474.

Informed consent statement: The need for signed informed consent was waived by the Institutional Review Board at University of California.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are publicly available through the Scientific Registry of Transplant Recipients (https://www.srtr.org/about-the-data/the-srtr-database/).

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Bima J Hasjim, Department of Surgery, UC Irvine, 3800 Chapman Ave, Orange, CA 92868, United States. bjhasjim@gmail.com

Received: April 15, 2025
Revised: May 23, 2025
Accepted: July 2, 2025
Published online: December 18, 2025
Processing time: 217 Days and 6.1 Hours

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.

Keywords: Orthotopic liver transplantation; Old allograft age; Elderly recipient; Survival; Recipient age; Functional status

Core Tip: The aging general population has led to changes in liver transplant (LT) recipient and donor demographics. In addition to older recipient age, older allografts are increasingly utilized to keep up with the demand for LT. In this study, we found that older donor:recipient age pairs were associated with a lower likelihood of improving functional status and distinct patterns of cause-specific mortality. Notably, graft- and infection-related mortality were strongly dependent on allograft age, whereas cardioneurovascular- and malignancy-related mortality were more linked with recipient age. These findings highlight the importance of age dynamics in LT and may inform age-matched organ allocation strategies.