OBJECTIVE: To investigate the impact of cumulative liver age on graft survival in liver transplant recipients. SUMMARY OF BACKGROUND DATA: Organ shortage has led to increased use of elderly donor livers for an ageing group of recipients, particularly in Europe. We hypothesized that hypothermic oxygenated perfusion (HOPE) enhances graft resilience against aging in livers from elderly donors. METHODS: This post-hoc analysis of the multicenter European HOPE-REAL study (NCT05520320) examined liver age in adult recipients of HOPE-treated brain-dead donor (DBD) livers. Cumulative liver age was defined as the sum of donor age and post-transplant graft survival. HOPE-treated DBD liver transplants were compared with a single-center control cohort of non-perfused DBD livers using propensity score matching to adjust for confounders. RESULTS: The median cumulative liver age was significantly higher in the HOPE-treated (n=768) cohort than in the non-perfused (n=863) group (69 vs. 61 years, P<0.001), yet graft survival was superior in the HOPE-treated group (log-rank P<0.001). After matching, cumulative liver age remained significantly higher in the HOPE group (P<0.001). Multivariate analysis identified HOPE as an independent predictor of cumulative liver age (P<0.001). CONCLUSIONS: HOPE treatment appears to mitigate the risks associated with transplanting elderly DBD livers, leading to excellent long-term survival in an ageing recipient population. These findings support broader adoption of HOPE to improve utilization of older donor livers and expand the donor pool.

Adult Liver Transplantation Unit Department of Surgery and Gastroenterology Coimbra Hospital and University Center Coimbra Portugal

Chirurgia Generale 2 Hepato Biliary Pancreatic Unit and Liver Transplant Center Padova University Hospital Padova Italy

CHU Rennes Service de Chirurgie Hépatobiliaire et Digestive Rennes France

Department of Abdominal Transplantation Leuven Transplant Center University Hospitals Leuven Leuven Belgium

Department of General Surgery and Transplantation ASST Grande Ospedale Metropolitano Niguarda Milan Italy

Department of General Surgery and Transplantation IRCCS Azienda Ospedaliero Universitaria of Bologna University of Bologna Bologna Italy

Department of Organ Failure and Transplantation ASST Papa Giovanni XXIII Bergamo Italy

Department of Surgery Section of Epidemiology and Statistics University of Groningen and University Medical Center Groningen Groningen the Netherlands

Department of Surgery Section of HPB Surgery and Liver Transplantation University of Groningen and University Medical Center Groningen Groningen the Netherlands

Department of Surgery Universitätsklinikum Heidelberg Heidelberg Germany

Department of Transplant Surgery University of Munich Grosshadern Gemany

Department of Visceral Surgery University of Basel Clarunis Basel Switzerland

Department of Visceral Transplantation University Medical Center Hamburg Eppendorf Hamburg Germany

Division of Transplantation Medical University of Vienna Vienna Austria

Erasmus MC Transplant Institute University Medical Center Rotterdam Division of HPB and Transplant Surgery Rotterdam the Netherlands

Fundeni Clinical Institute Center of General Surgery and Liver Transplantation; Titu Maiorescu University Bucharest

General and Liver Transplant Surgery Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy

General Surgery 2U Liver Transplant Centre Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino Turin Italy

Hepato Pancreato Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio Emilia Modena Italy

Swiss HPB and Transplant Center Department of Visceral Surgery and Transplantation University Hospital Zurich Zurich Switzerland

Transplant Institute Sahlgrenska University Hospital Gothenburg Sweden

Transplant Surgery Department Institute for Clinical and Experimental Medicine Prague Czech Republic

UMCG Comprehensive Transplant Center Groningen the Netherlands

Citace poskytuje Crossref.org