Born to Be Accepted: Donor age Association With One-year Rejection in Deceased Donor Kidney Transplants.

Background: Kidneys from pediatric donors are underutilized, in part because of concern about acute rejection. This study evaluated the association between donor age and 1-y acute rejection after deceased-donor kidney transplantation. Methods: We retrospectively analyzed Scientific Registry Of Transplant Recipients data from 2014 to 2025 for first-time, deceased-donor, adult kidney recipients. The primary outcome was any reported acute rejection episode within 12-mo posttransplant, modeled by multivariable generalized estimating equations logistic regression clustered by transplant center and restricted to pretransplant covariates. Donor age was a 5-level categorical variable with post hoc, data-derived cut-points at 3.5, 18.3, 34.3, and 61.3 y from locally estimated scatterplot smoothing inflection points. A secondary model split the reference group by en bloc versus non-en bloc procedures. Population-standardized adjusted probabilities increased from 3.9% (2.9-5.0) to 9.1% (8.2-10.0). En bloc allografts differed significantly from all four older strata; non-en bloc allografts from the 2 oldest only. Conclusions: Younger ages of deceased-donors are associated with up to 60% lower adjusted odds of 1-y rejection. Donor age appears to have an independent association with early acute rejection.