Livers have the potential to function for mor

Key takeaway

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

• Optimizing both donor and recipient factors allows for much greater longevity for some livers.

SAN DIEGO: There is a small, but growing, subset of livers that have been transplanted and have a cumulative age of over 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 characteristics to determine why these organs are so resilient, paving the way for considering the potential expanded use of older liver donors. The research team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022.

The researchers used the United Network for Organ Sharing (UNOS) STARfile to identify livers that had a cumulative age (initial total age at transplant plus post-transplant survival) of at least 100 years. Of the 253,406 livers transplanted between 1990 and 2022, 25 met the criteria for centurion livers, those with a cumulative age greater than 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 extraordinary livers with a survival of over 100 years and identified donor factors, recipient factors and transplant factors involved in creating this unique combination in which the liver was able to live for up to 100 years.”

Centurion livers came from older donors

For these centurion livers, the mean donor age was significantly higher, 84.7 years compared to 38.5 years for non-centurion liver transplants. The researchers noted that for a liver to go up to 100, they expected to find an older middle-aged donor and healthier donors. Notably, donors in the centurion group had a lower incidence of diabetes and fewer donor infections.

“We previously tended to avoid using livers from older donors,” said study co-author Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can figure out what’s special about these donors, we could potentially get more livers available to transplant and have good results.”

There are 11,113 patients on the waiting list for liver transplantation as of September 22, 2022. * As Dr. Hwang noted, the more frequent use of older liver donors could potentially expand the liver donor pool.

Further study details

Centurion’s liver donors had lower transaminases, which are enzymes that play a key role in the liver. Elevated transaminases can cause liver transplant problems. Furthermore, centurion liver recipients had significantly lower MELD scores (17 for the centurion group, 22 for the non-centurion group). A higher MELD score indicates that a patient is in more urgent need of a transplant.

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

The researchers found that no grafts in the centurion group were lost due to primary nonfunction or vascular or biliary complications. There was in particular no significant difference in the 12-month rejection rates between the centurion group and the non-centurion group. Furthermore, the results for the centurion group had significantly better allograft and patient survival.

“The existence of allografts over 100 years is revealing the liver’s dramatic resilience to senescent events,” concluded the study authors.

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

Co-authors of the study 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 Congress 2022.

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* Data. Organ Supply and Transplant Network. Accessed September 23, 2022. Available on: https://optn.transplant.hrsa.gov/data/ (.)

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About American College of Surgeons 

The American College of Surgeons is a scientific and educational organization of surgeons founded in 1913 to raise the 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 findings significantly influenced the course of scientific surgery in America and established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest surgeon organization in the world. “FACS” indicates that a surgeon is a Fellow of the American College of Surgeons.