• Annals of surgery · Mar 2024

    Age Matters: What Affects the Cumulative Lifespan of a Transplanted Liver?

    • Chase J Wehrle, Marianna Maspero, Antonio D Pinna, Philipp Dutkowski, Charles Miller, Koji Hashimoto, Pierre-Alain Clavien, and Andrea Schlegel.
    • Transplantation Center, Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, US.
    • Ann. Surg. 2024 Mar 11.

    ObjectiveAssess factors affecting the cumulative lifespan of a transplanted liver.Summary Background DataLiver ageing is different from other solid organs. It is unknown how old a liver can actually get after liver transplantation (LT).MethodsDeceased donor liver transplants from 1988-2021 were queried from the United States (US) UNOS registry. Cumulative liver age was calculated as donor age + recipient graft survival.ResultsIn total, 184,515 livers were included. Most were DBD-donors (n=175,343). The percentage of livers achieving >70, 80, 90 and 100years cumulative age was 7.8% (n=14,392), 1.9% (n=3,576), 0.3% (n=528), and 0.01% (n=21), respectively. The youngest donor age contributing to a cumulative liver age >90years was 59years, with post-transplant survival of 34years. In pediatric recipients, 736 (4.4%) and 282 livers (1.7%) survived >50 and 60years overall, respectively. Transplanted livers achieved cumulative age >90years in 2.86-per-1000 and >100years in 0.1-per-1000. The US population at-large has a cumulative "liver age" >90years in 5.35-per-1000 persons, and >100y in 0.2-per-1000. Livers aged>60 years at transplant experienced both improved cumulative survival ( P <0.0001) and interestingly improved survival after transplantation ( P <0.0001). Recipient warm-ischemia-time of >30minutes was most predictive of reduced cumulative liver survival overall (n=184,515, HR=1.126, P <0.001) and excluding patients with mortality in the first 6month (n=151,884, HR=0.973, P <0.001).ConclusionsIn summary, transplanted livers frequently get as old as those in the average population despite ischemic-reperfusion-injury and immunosuppression. The presented results justify using older donor livers regardless of donation type, even in sicker recipients with limited options.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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