Livers have the potential to function for over 100 years

The central theses

• New surgical techniques and advances in immunosuppression are leading to better outcomes for patients receiving a liver from an elderly donor.

• Optimizing both donor and recipient factors allows for much longer lifespans for certain livers.

SAN DIEGO: There is a small but growing subset of livers that have been transplanted that have a combined age of more than 100 years, according to researchers at the University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover. Massachusetts. They studied these livers to identify features to determine why these organs are so resilient and paved the way for considering the potential expanded use of older liver donors. The research team presented their findings at the 2022 American College of Surgeons (ACS) Clinical Congress Scientific Forum.

Researchers used the United Network for Organ Sharing (UNOS) STAR file to identify livers that had a cumulative age (total age at transplantation plus post-transplant survival) of at least 100 years. Of 253,406 livers transplanted between 1990 and 2022, 25 livers met the criteria to be Centurion livers – those with a combined age of over 100 years.

“We looked at pre-transplant survival — essentially the age of the donor — as well as how long the liver survived in the recipient,” said study lead author Yash Kadakia, a medical student at UT Southwestern Medical School. “We stratified these remarkable livers with a survival time of over 100 years and identified donor factors, recipient factors and engraftment factors involved in creating this unique combination that has allowed the liver to live for 100 years.”

Centurion livers were from older donors

In these Centurion livers, the mean donor age was significantly higher, 84.7 years compared to 38.5 years for non-Centurion livers. The researchers noted that for a liver that lives to be 100 years old, they would expect a higher average donor age as well as healthier donors. Notably, the Centurion group donors had a lower incidence of diabetes and fewer donor infections.

“In the past, we were more reluctant to use livers from older donors,” said study co-author Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can find out what’s special among these donors, we could potentially get more available livers for transplantation and get good results.”

As of September 22, 2022, there were 11,113 patients on the liver transplant waiting list.* As Dr. Hwang noted, using older liver donors more frequently could potentially expand the liver donor pool.

More study details

Centurion liver donors had lower levels of transaminases, which are enzymes that play a key role in the liver. Elevated transaminases can cause liver transplant problems. In addition, recipients of Centurion livers had significantly lower MELD scores (17 for Centurion group, 22 for non-Centurion group). A higher MELD score indicates that a patient needs a transplant more urgently.

“The donors have been optimized, the recipients have been optimized, and it takes this unique overlap of factors to result in a really good outcome,” said Mr. Kadakia.

The researchers found that no grafts in the Centurion group were lost due to primary nonfunction or vascular or biliary complications. Specifically, there was no significant difference in rejection rates at 12 months between the Centurion group and the non-Centurion group. In addition, the results for the Centurion group had significantly better allograft and patient survival.

“The existence of allografts over 100 years old demonstrates the dramatic resilience of the liver to aging events,” the study authors concluded.

“Livers are incredibly resilient organs,” said Mr. Kadakia. “We are using older donors, we have better surgical techniques, we have advances in immunosuppression, and we have a better match of donor and recipient factors. All of these things allow us to achieve better results.”

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

Citation: Kadakia Y, et al. Centurion Livers – Get to 100 with a transplant, Scientific ForumAmerican College of Surgeons Clinical Convention 2022.

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* Data. Organ procurement and transplant network. Retrieved September 23, 2022. Available at: https://optn.transplant.hrsa.gov/data/ (.)

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons established in 1913 to raise standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements significantly influenced the course of scientific surgery in America, making it a major advocate for all surgical patients. The College has more than 84,000 members and is the largest surgeon organization in the world. “FACS” denotes that a surgeon is a Fellow of the American College of Surgeons.