Introduction: The Quest for the Fifty-Year Graft
In the realm of solid organ transplantation, the adolescent recipient represents a unique clinical challenge. Unlike adult recipients, for whom a graft survival of 15 to 20 years may constitute a successful lifelong outcome, an adolescent undergoing liver transplantation (LT) at age 15 ideally requires that graft to function for 50 or 60 years. Consequently, maximizing the durability of the initial transplant is paramount to avoiding the morbidity and mortality associated with re-transplantation later in life.
While donor-recipient age mismatch has long been recognized as a significant variable in adult liver transplantation, its specific impact on the adolescent cohort—those aged 12 to 17—has remained under-characterized. Current allocation policies in the United States prioritize pediatric candidates, yet a significant portion of adolescent-derived donor livers are still allocated to adult recipients. This raises a critical question for transplant surgeons and policy-makers: does the use of older donor grafts for adolescent recipients compromise long-term outcomes, and if so, can geographic allocation policies be adjusted to mitigate this risk?
