Livers transplanted from older donors can last a century in total and sometimes outlive ones from younger people.
Transplanting livers from older donors after they die is generally avoided because livers tend to accumulate more scarring over time, caused by factors such as drinking alcohol, obesity and viral infections.
Now, researchers have provided evidence that transplants from older donors can work very well.
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and Yash Kadakia at the University of Texas Southwestern Medical Center and their colleagues analysed data covering 253,406 liver transplants from deceased donors that occurred in the US between 1990 and 2022.
The team found that 25 livers had lasted for at least 100 years across both the donors’ and recipients’ bodies, with 14 still remaining in their recipients. The oldest liver was aged 108.
“The wow factor to this study is having 25 patients with [100-year-old] livers,” says Kadakia.
“We do not know of any other types of organ transplants that have lasted 100 years,” says Hwang.
All livers that eventually reached the age of 100 lasted for at least a decade in the recipient, while 60 per cent of livers that didn’t reach 100 lasted for a decade after transplantation, the team told the in San Diego, California, today.
People who donated livers that reached the age of 100 were aged 84 when they died, on average, while those who donated livers that failed to survive for 100 years had an average age of 38 when they passed away. This provides evidence that older donors can sometimes contribute more successful liver transplants than younger ones.
“People tend to shy away from older livers, but this study shows that older livers, from older donors, can function very well in some cases,” says Kadakia.
By analysing blood sample data collected from donors soon after they died, the team found that donors of livers that survived for a century had a lower level of blood enzymes called transaminases – associated with inflammation and liver injury – than people who donated livers that didn’t make it to 100.
Using a mathematical model that aids transplant decisions in the clinic, the team then found that livers that made it to 100 lasted longer than would have been expected based on a variety of donor and transplant recipient factors, such as the presence of other diseases, age, sex, ethnicity and body mass index.
This suggests the model may not account for key unknown factors that determine how long livers last. It isn’t known if the findings would apply to liver transplants that take place outside the US.
“Studying these livers that made it to age 100 could reveal new biomarkers that are important for liver lifespan,” says Kadakia. “Manipulating such markers in livers before transplantation could help us improve the outcome.”
“It is important that this study shows that good-quality donor livers that are older can go on to do very well in their new recipients,” says at the University of Birmingham, UK. “We need as many donor organs as possible to address increasing requirements for transplantation.”
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