Objective The aim of this study was to investigate whether donor age was a predictor of outcomes in liver transplantation, representing an independent risk factor as well as its impact related to recipient age-matching. Methods We analyzed prospectively collected data from 221 adult liver transplantations performed from January 2006 to September 2009. Results Compared with recipients who received grafts from donors <60 years old, transplantation from older donors was associated with significantly higher rates of graft rejection (9.5% vs 3.5%; P =.05) and worse graft survival (P =.021). When comparing recipient and graft survivals according to age matching, we observed significantly worse values for age-mismatched (P values.029 and.037, respectively) versus age-matched patients. After adjusting for covariates in a multivariate model, age mismatch was an independent risk factor for patient death (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.1-4.17; P =.027) and graft loss (HR 3.86, 95% CI 1.02-15.47; P =.046). Conclusions The results of this study suggest to that optimized donor allocation takes into account both donor and recipient ages maximize survival of liver-transplanted patients. © 2013 by Elsevier Inc. All rights reserved.