A new study suggests that our livers could work for more than 100 years, to the point where they outlast their owners.
Findings from research on a special group of transplanted livers could help boost the age of potential donors, which would increase the number of donors in the future, according to the authors.
According to experts from the University of Texas (UT) Southwestern Medical Center in Dallas and TransMedics in Andover, Massachusetts, there is a tiny but growing subset of livers that have been transplanted and have a combined age of more than 100 years.
It opened the door for thinking about the possibility of expanding the use of older liver donors by identifying factors that explain why these organs are so resilient.
This study was presented at the 2022 ACS Clinical Congress Scientific Forum.
Using the United Network for Organ Sharing (UNOS) STARfile, the researchers identified livers with a cumulative age of at least 100 years (total starting age at transplant plus post-transplant survival).
25 of the 253,406 livers transplanted between 1990 and 2022 qualified as centurion livers, defined as those with a cumulative age of over 100 years.
“We looked at pre-transplant survival—essentially, the donor’s age—as well as how long the liver went on to survive in the recipient,” added lead study author Yash Kadakia. “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 these centurion liver transplants was 84.7 years, which is noticeably older than 38.5 years for non-centurion liver transplants.
For a liver to live to age 100, the researchers anticipated a higher average donor age as well as healthier donors. Notably, there were fewer donor infections and cases of diabetes among the centurion group donors.
“We previously tended to shy away from using livers from older donors,” agreed study coauthor Christine S. Hwang. “If we can sort out what is special amongst these donors, we could potentially get more available livers to be transplanted and have good outcomes.”
As of September 22, 2022, there are 11,113 people on the liver transplant waiting list. As Dr. Hwang pointed out, employing older liver donors more often might increase the number of available liver donors.
Transaminases, which are important enzymes in the liver, were shown to be lower in centurion liver donors. Transplanting a liver can be complicated by elevated transaminases.
Furthermore, the centurion liver recipients had considerably lower MELD scores (17 for the centurion group, 22 for the non-centurion group). A patient who needs a transplant more urgently will have a higher MELD score.
“The donors were optimized, the recipients were optimized, and it takes that unique intersection of factors to result in a really good outcome,” added Mr. Kadakia.
In the centurion group, no grafts were lost due to primary nonfunction, vascular, or biliary problems, as determined by the researchers.
Notably, there was no discernible difference between the non-centurion group and the centurion group in the rates of rejection at 12 months.
Additionally, the centurion group’s outcomes included significantly longer allograft and patient survival.
“The existence of allografts over 100 years old is revealing of the dramatic resilience of the liver to senescent events,” concluded the study authors.
“Livers are incredibly resilient organs,” added Mr. Kadakia. “We’re using older donors, we have better surgical techniques, we have advances in immunosuppression, and we have better matching of donor and recipient factors. All these things allow us to have better outcomes.”
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