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; Andrea Schlegel

doi:10.1097/SLA.0000000000006259

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

Ann Surg. 2024 Mar 11. doi: 10.1097/SLA.0000000000006259. Online ahead of print.

Authors

Chase J Wehrle¹, Marianna Maspero^{1

2}, Antonio D Pinna³, Philipp Dutkowski⁴, Charles Miller¹, Koji Hashimoto¹, Pierre-Alain Clavien⁵, Andrea Schlegel^{1

6}

Affiliations

¹ Transplantation Center, Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, US.
² Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
³ Cleveland Clinic Florida, Weston, Florida, US.
⁴ Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
⁵ Wyss Zurich, ETH Zurich and University of Zurich, Switzerland.
⁶ Department of Immunology, Lerner Research Institute, Cleveland Clinic, Ohio, US.

PMID: 38489660
DOI: 10.1097/SLA.0000000000006259

Abstract

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 ( 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).

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.