Introduction: Pediatric liver transplantation outcomes improve when donors and recipients are age-matched. We hypothesized that graft survival would be longer when children received age-matched donor livers.

Methods: The United Network of Organ Sharing database was reviewed for pediatric deceased donor liver transplant patients ≤18 years of age undergoing liver transplantation from 2000-2024. Recipients were divided into 3 groups: 1) age difference of less than 9 years, 2) age difference of 10-19 years and 3) age difference of 20+ years. We additionally separated out whether they were admitted to ICU/hospital or came from home. Primary outcomes examined included overall graft survival, graft survival after 1 year and 5 years. Cofounders examined included type of graft, age of donor, cold ischemia time, pediatric diagnosis, PELD score, and time on wait list.

Results: There were a total of 2, 691 patients included. By group, 2,059 patients had age difference between recipient and donor of less than 9 years, 295 within 10-19 years and 337 of 20+ years. Overall graft survival, graft survival after 1 year and graft survival after 5 years were all significantly longer when there was less of a difference in age between donor and recipient.

Conclusion: If children are stable, we should age-match deceased donor livers to pediatric recipients when able. Long term graft survival is demonstrated to be superior when donor and recipient are closer in age.