The liver has the ability to work for more

Centurion Liver Infographic

Photo: The liver has the ability to function for more than 100 years
Opinion more

Credit: American College of Surgeons

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  • New surgical techniques and advances in immunosuppression lead to better outcomes for patients who receive livers from an older donor.

  • Improving donor and recipient factors allows the lifespan of some livers to be extended.

San Diego: There is a small but growing subset of transplanted livers with a cumulative life of more than 100 years, according to researchers from the University of Texas (UT) Southwestern Medical Center, Dallas, and Trans Medix, Andover, Massachusetts. They studied these livers for characteristics to determine why these organs are so flexible, paving the way for consideration of the potential expanded use of older liver donors. The research team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) 2022 Clinical Conference.

The researchers used the United Network for Organ Sharing (UNOS) STAR file to identify a liver that had a cumulative lifespan (total initial life at transplant plus survival after transplantation) of at least 100 years. Of the 253,406 livers transplanted between 1990 and 2022, 25 met the criteria for being 100th livers—those over 100 years old.

“We looked at pre-transplant survival — essentially, the age of the donor — as well as how long the liver lasted for survival in the recipient,” said senior study author Yash Kadakia, a medical student at UCSD Southwestern College of Medicine. “We stratified these remarkable livers with over 100-year survivals and identified the donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live up to 100 years.”

Centurion’s liver came from older donors

For these centurion livers, the mean donor age was significantly higher, 84.7 years compared to 38.5 years for liver transplants without a centurion. For the liver to reach 100, the researchers noted, they would expect to find an older donor and a healthier donor. Notably, donors from the 100 group had a lower rate of diabetes and lower infection than the donors.

“Previously we tended to shy away from using livers from older donors,” said Kristin S. Huang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can identify what is special among these donors, we will likely have more livers available to be transplanted and achieve good results.”

There are 11,113 patients on the liver transplant waiting list as of September 22, 2022. * As pointed out by Dr. Huang, using elderly liver donors more often can expand the liver donor pool.

More study details

Centurion liver donors had fewer transaminases, enzymes that play a major role in the liver. Elevated transaminases can cause problems in liver transplantation. In addition, Centurion liver recipients had significantly lower MELD scores (17 for the Centurion group, 22 for the non-centurion group). A higher MELD score indicates that the patient is in urgent need of a transplant.

“Donors are improved, recipients are improved, and it takes this unique intersection of factors to achieve a really good outcome,” said Mr. Kadakia.

The researchers found that no graft was lost in the 100 group due to primary nonfunctional or vascular or biliary complications. There was no significantly significant difference in rejection rates at 12 months between the hundred group and the non-hundred group. Furthermore, the results of the hundred group were significantly better than the allograft and patient survival.

The study authors concluded that “the presence of an allograft over 100 years old reveals the liver’s tremendous resilience in the face of aging events.”

“The liver is incredibly flexible,” said Mr. Kadakia. “We use older donors, we have better surgical techniques, we have advances in immunosuppression, and we have better matching between donor and recipient factors. All of these things allow us to get better results.”

Study co-authors are Malcolm McConmara, MBBCh, FACS; Madhukar S. Patel, MD; Jigesh A. Shah, Doe; Stephen I. Hansch, MD, FACS; and Parsia A. Vagefi, MD, FACS.

the quote: Kadakia Way et al. Centurion liver – make it up to 100 with a transplant, Scientific ForumClinical Conference of the American College of Surgeons 2022.


* Data. Organ Procurement and Transplantation Network. Accessed September 23, 2022. Available at: (.)

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about American College of Surgeons

The American College of Surgeons is a scientific and educational organization for surgeons founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The college is dedicated to the practice of ethical and competent surgery. His achievements have greatly influenced the course of scientific surgery in America and made her an important advocate for all surgical patients. The college has more than 84,000 members and is the largest organization of surgeons in the world. FACS identifies the surgeon as a Fellow of the American College of Surgeons.

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