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Publications

Journal Article Ahead of print

PubMed: 40772946 DOI: 10.1097/SLA.0000000000006883

Life Expectancy of Transplanted Livers - HOPE Against Aging?

Ann Surg

Authors: Janina Eden, Philip C Müller, Christoph Kuemmerli, Noa Aegerter, Isabel Ma Brüggenwirth, Gabriela Berlakovich, Bettina M Buchholz, Florin Botea, Stefania Camagni, Matteo Cescon, Umberto Cillo, Fabio Colli, Luciano G De Carlis, Riccardo De Carlis, Fabrizio Di Benedetto, Jule Dingfelder, Dulce Diogo, Daniele Dondossola, Moritz Drefs, Jiri Fronek, Giuliana Germinario, Enrico Gringeri, Christiano Guidetti, Georg Györi, Matej Kocik, Efrayim H Küçükerbil, Dionysios Koliogiannis, Georg Lurje, Paolo Magistri, Diethard Monbaliu, Mostafa El Moumni, Beat Müller, Damiano Patrono, Wojciech G Polak, Robert J Porte, Matteo Ravaioli, Michel Rayar, Renato Romagnoli, Gustaf Sörensen, Deniz Uluk, Pierre A Clavien, Vincent E de Meijer, Philipp Dutkowski

Affiliations

  • Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
  • UMCG Comprehensive Transplant Center, Groningen, the Netherlands.
  • Department of Visceral Surgery, University of Basel, Clarunis, Basel, Switzerland.
  • Division of Transplantation, Medical University of Vienna, Vienna, Austria.
  • Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Fundeni Clinical Institute, Center of General Surgery and Liver Transplantation; "Titu Maiorescu" University, Bucharest.
  • Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria of Bologna, University of Bologna, Bologna, Italy.
  • Chirurgia Generale 2, Hepato-Biliary-Pancreatic Unit and Liver Transplant Center, Padova University Hospital, Padova, Italy.
  • General Surgery 2U, Liver Transplant Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
  • Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
  • Adult Liver Transplantation Unit, Department of Surgery and Gastroenterology, Coimbra Hospital and University Center, Coimbra, Portugal.
  • 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.
  • Department of Transplant Surgery, University of Munich Grosshadern, Gemany.
  • Transplant Surgery Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
  • Erasmus MC Transplant Institute, University Medical Center Rotterdam, Division of HPB and Transplant Surgery, Rotterdam, the Netherlands.
  • Department of Surgery, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • Department of Abdominal Transplantation, Leuven Transplant Center, University Hospitals Leuven, Leuven, Belgium.
  • Department of Surgery, Section of Epidemiology and Statistics, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
  • CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.
  • Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Swiss HPB and Transplant Center, Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.

Abstract

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.

MeSH

Liver Transplantation, Aging, Life Expectancy, Graft Survival, Liver, Aged, Transplants, General Surgery