Prolonged allograft survival in liver transplantation

Abstract

Introduction: Donor age has traditionally been considered a factor associated with allograft failure in liver transplantation. We sought to examine the characteristics and outcomes of all liver allografts with a cumulative age of over 80 years within the US to better understand liver senescence.

Methods: Using the UNOS STARfile, allografts with a cumulative age (sum of age at transplant plus post-transplant survival) of octogenarian, 90-99 nonagenarian, and 100 years or greater (centurion) were identified from all adult transplant recipients between 1990 and 2022. Donor and recipient data as well as outcomes were analyzed.

Results: There were 3437 octogenarian, 622 nonagenarian, and 29 centurion allografts. Donors from allografts with prolonged cumulative age had less diabetes, less alcohol use, and fewer infections compared to all other donors. Recipients had significantly lower MELD scores at the time of transplant and dialysis rates.

Conclusions: Careful matching of older donors with lower MELD recipients results in excellent outcomes as evidenced by the presence of prolonged cumulative age livers, demonstrating the resilience of the liver to senescent events in appropriately matched recipients.

Keywords: Donor age; Liver; Outcomes; Transplant.

Fig. 1

Allograft and patient survival. (A) Allograft Survival of Groups with Prolonged Cumulative Survival. (B) Patient Survival of Groups with Prolonged Cumulative Survival.

Fig. 2

Cumulative incidence of centurion livers.

Fig. 3

Geographic distribution of centurion livers. Map adapted from UNOS.org

Fig. 4

Donor age, recipient age, and posttransplant survival among centurion livers.

Fig. 5

Center distribution for cumulative age 100 + (Centurion, A), 90–100 (B) and (80–90).