Age Matters
Chase J Wehrle, Marianna Maspero, Antonio D Pinna, Philipp Dutkowski, Charles Miller, Koji Hashimoto, Pierre-Alain Clavien, Andrea Schlegel- Surgery
Objective:
Assess factors affecting the cumulative lifespan of a transplanted liver.
Summary Background Data:
Liver ageing is different from other solid organs. It is unknown how old a liver can actually get after liver transplantation (LT).
Methods:
Deceased 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.
Results:
In 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 (
Conclusions:
In 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.