The liver has the potential to maintain its function for more than 100 years

Key content

• Understanding the characteristics of livers that live to be 100 years old allows you to expand the donor pool
  by using older liver donors more frequently.
  

• Advances in new surgical techniques and immunosuppressive techniques have led to better outcomes
  for patients receiving elderly donor livers.
  

• Optimizing donor and recipient factors can lead to a longer
  lifespan for some livers.
  

According to researchers at the University of Texas (UT), there is a small, but growing group of liver transplants with a cumulative age of more than 100.

They studied these livers to characterize them and determine why they are so resilient, paving the way
for considering potential uses for expanding older liver donors.
The research team presented their findings
at the 2022 American College of Surgeons (ACS) Clinical Congress Scientific Forum.

The researchers used the STARfile of the United Network for Organ Sharing (UNOS) to identify livers
with at least 100 years of cumulative age (total initial age at transplant plus survival time after transplantation).
Of the 253,406 livers transplanted between 1990 and 2022, 25 met the criteria for centurion livers — those with a
cumulative age of more than 100 years.

"We looked at pre-transplant survival rates — primarily the donor's age — and how long the liver survived in the recipient," said
Yash Kadakia, lead author of the study and a medical student at the University of Texas Southwestern Medical School.
"We stratified these outstanding livers that survived for more than 100 years and identified the donor, recipient, and transplant factors involved in creating this unique combination that allowed the liver to survive for 100 years
.
"

Centurion's liver comes from an older donor

The average donor age of these centurions was significantly higher than that of non-centurions at 38.
5 years, at 84.
7 years
.
The researchers note that to make a liver live to be 100 years old, they hope to find a donor with an older average age, as well as a healthier one
.
Notably, donors from the centurion group had a lower incidence of diabetes and fewer
donor infections.

"We previously tended to avoid livers from older donors," said study co-author Christine S.
Hwang, MD, FACS, associate professor
of surgery at the University of Texas Southwestern Medical Center.
"If we can figure out what makes these donors special, we may have the potential to get more livers available for transplantation and achieve good results
.
"

As of September 22, 2022, there are 11,113 patients
on the liver transplant waiting list.
*As Dr.
Huang points out, greater use of older liver donors may expand the number of
liver donors.

Investigate the details further

Centurion liver donors are lower in transaminases, an enzyme that plays a key role
in the liver.
Elevated transaminases can cause problems
in liver transplantation.
In addition, patients who received centurion's liver had significantly lower MELD scores (17 in the centurion group versus 22 in the non-centurion group).

The higher the MELD score, the more urgent
the patient's need for a transplant.

"The donor is optimized, the recipient is optimized, and it's the unique intersection of these factors that produces really good results," Kadachia said
.

The researchers found that no grafts in the centurion group were lost
due to primary nonfunction or vascular or biliary complications.
At 12 months, there was no significant difference in
rejection rates between the centurion and non-centurion groups.
In addition, the centurion group resulted in significantly better allogeneic transplantation and patient survival
.

"The presence of allogeneic transplants over 100 years of age reveals the great elasticity of the liver to aging events," concludes the study authors
.

"The liver is a very tough organ," Kadachia said
.
"We're using older donors, we have better surgical techniques, we've made advances in immunosuppression, we have better donor and recipient factor matching
.
" All of this allows us to achieve better results
.
”

Study co-authors are Malcolm MacConmara, MBBCh, FACS; Madhukar S.
Patel, M.
D.
; Gigish A.
Shah, DO; Steven I.
Hanish, M.
D.
, FACS; Parsia A.
Vagefi, MD, FACS
.