Livers Can Function for 100 Years and Potentially Expand Pool of Eligible Donors

Livers can continue functioning for over 100 years in the right scenario, which can expand the pool of eligible donors and get more patients off the waiting list for a transplant.

Using older liver donors may be feasible based on a small number of livers that have been transplanted with a cumulative age of more than 100 years. Researchers from University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover, Massachusetts, studied these livers to understand their characteristics and presented findings at the Scientific Forum of the American College of Surgeons Clinical Congress 2022. The meeting was held October 16-20, 2022, in San Diego, California.

A total of 253,406 livers were transplanted between 1990 and 2022, and of those, 25 livers were considered centurion livers with a cumulative age over 100 years. The researchers used the United Network for Organ Sharing STARfile to identify livers.

“We looked at pretransplant survival—essentially, the donor’s age—as well as how long the liver went on to survive in the recipient,” lead study author Yash Kadakia, a medical student at UT Southwestern Medical School, said in a statement. “We stratified out these remarkable livers with over 100-year survival and identified donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live to 100 years.”

The average donor age for a centurion liver was 84.7 years compared with 38.5 years for noncenturion liver transplants. The older donors had lower incidence of diabetes and fewer infections.

With roughly 11,000 people waiting for a liver transplant, understanding why these older donors were successfully can expand the pool of available livers to be transplanted with good outcomes, according to study coauthor Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center.

Among the characteristics identified for centurion livers were:

• Lower transaminases—elevated transaminases can cause problems in liver transplantation
• Lower Model for End-stage Liver Disease (MELD) for the recipients of centurion livers vs recipients of noncenturion livers—a higher MELD score indicates the patient more urgently needs the transplant

There was no significant difference in rates of rejection at 12 months between patients who received centurion livers and those who received noncenturion livers. Patients in the centurion group had significantly better allograft and patient survival. No graft in patients receiving centurion livers were lost to primary nonfunction or vascular or biliary complications.

“The donors were optimized, the recipients were optimized, and it takes that unique intersection of factors to result in a really good outcome,” Kadakia said.

He also attributed the success of centurion livers to better surgical techniques, advances in immunosuppression, and better matching of donor and recipient factors.

“All of these things allow us to have better outcomes,” Kadakia said.