*Purpose: Although the importance of donor and recipient age in liver transplant (LT) are well-studied, the prognostic influences of donor and recipient age differences are still unknown. Especially, since young recipient have a long life expectancy, the influence of the old donor liver on their long-term prognosis should be elucidated. The study aims to reveal the long-term prognostic influence of donor-recipient age difference in young recipients.

*Methods: Adult patients who received initial LT using brain dead donor between 2002 and 2020 were identified from the UNOS database. Patients who received pediatric donor and split liver grafts were excluded. Young recipient was defined as ≤ 45 year old. The age difference between donor and recipient was categorized as follows: Group 1: younger than recipient, Group 2: ≤10 years older, Group 3: 10-19 years older, Group 4: 20 years or older. To examine the influence of donor recipient age difference in long-term survivors, conditional survival (CS) analysis was conducted.

*Results: Among 89145 patients, 14258 patients were ≤ 45 years old (16.3%), which were categorized into 5839 (41.0%) as Group 1, 3390 (23.8%) as Group 2, 2488 (17.5%) as Group 3, 2541 (17.8%) as Group 4. The recipient and donor characteristics are summarized (Table). The actual overall survival, 5-years CS, and 10-year CS according to the donor recipient age differences are shown (Figure). Among the recipients who survived 5-years from LT, the survival curves were divided into two clusters (Group 1 and 2 vs. Group 3 and 4). This trend was more prominent when the recipient survived longer than 10 years from LT.

*Conclusions: Donor and recipient age difference affected not only short term but also in long-term after LT. When the donor is ≥ 10 years older, a significant difference in survival in long-term was confirmed. Transplanting a donor liver of ≤10 years difference should be considered in young patients who are expected to have a long term prognosis.

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