On the 99 I bought with 210k it needed:
a rear pinion seal (leaking)
new ball joints up front (wandering steering)
new track bar (same)
new lift pump (didn't know until I put a gauge on it)
3rd gear syncro (grinding)
abs sensor (brake light on and speedo didn't work until 25mph)
I don't have a 53 block, but from what I understand it is a coolant passage. It seems that the only thing that increases/decreases stress in that area would be the water pump and temperatures both outside and the coolant temps, right??? If that's true, mods *shouldn't* contribute to failure. A failed tstat would be much more dangerous. Also there seem to be far fewer failures on higher mile engines--don't forget that lots of 53 blocks never fail. Obviously the safe route is to avoid them altogether.
all of the above besides the tranny (double clutch does fine) are fixed along with a freespin kit, chip with gauges, and fass fuel pump are on for under $2000. Absolutely love the truck. It's a 99 as well.