Purpose Lack of organ donors demands transplantation of older lungs into younger recipients. Providing that other general organ donor selection criteria are fulfilled; it still remains questionable whether high age mismatch negatively affects short- and long-term outcomes. Here we investigate outcomes of lung recipients aged between 0 and 50 years whose donors had a high or low age mismatch compared to their respective recipients. Methods Records of patients aged between 0 and 50 years (33±12 years) and transplanted between 2005 and 2020 were retrospectively reviewed. Two groups were formed, one including recipients who received organs from donors at least 20 years older (high-mismatch group) and the other group including recipients whose donors were not older than 10 years (low-mismatch group) compared to their corresponding recipients. Donor smoking status, pO2-pressure and ventilation time (days) were evaluated. Incidence of Primary Graft Dysfunction grade 3 (PGD 3), ICU stay, ventilation time, perioperative hospital stay, chronic lung allograft dysfunction (CLAD) and graft survival were compared using Chi-Square test, Mann-Whitney-U test and Kaplan-Meier analysis, respectively. Results During the study period, among the 1722 patients transplanted at our institution, 172 (9.9 %) patients form the high-mismatch group and 212 (12.3%) patients the low mismatch group. Prevalence of donor smoking history was higher in low-mismatch recipients (34% vs. 46%; p=0.024). PO2-pressure (390 vs. 405 mmHg; p=0.39) and median ventilation time (4 vs. 4 days; p=0.898) prior organ procurement did not differ between groups. Incidence of PGD Grade 3 after 48 (11% vs. 6%; p=0.078) and 72 (11% vs. 6%; p=0.078) hours was not significantly different. Median mechanical ventilation (14 vs. 14 hours; p=0.76), ICU stay (4 vs. 4 days; p=0.6) and postoperative hospital stay times (25 vs. 24 days; p=0.17) did not differ between groups. At 5- and 10-year follow-up, overall graft survival (66.3% vs. 67.3%, 54% vs. 48%, p=0.956), patient survival conditioned to hospital discharge (75.7% vs. 79.2%, 62.9% vs. 64.1%, p=0.541) and freedom from CLAD (57.6% vs. 62.9%, 47% vs. 38%, p=0.944) was comparable between the groups. Conclusion Age mismatch alone is not a limiting factor for accepting donor lungs. Long term survival and incidence of CLAD are not affected providing general donor organ selection criteria are considered.