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Hypothermic oxygenated perfusion (HOPE) improves graft survival in liver transplant recipients, even when using older donor livers. This technique enhances graft resilience, leading to excellent long-term outcomes in an aging population.

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Area of Science:

  • Hepatology and Transplant Surgery
  • Organ Preservation Techniques
  • Geriatric Medicine in Transplantation

Background:

  • Increasing organ shortage necessitates using older donor livers for aging recipients.
  • Hypothermic oxygenated perfusion (HOPE) is hypothesized to improve the resilience of elderly donor livers.

Purpose of the Study:

  • To investigate the impact of cumulative liver age on graft survival in liver transplant recipients.
  • To evaluate if HOPE treatment mitigates risks associated with elderly donor livers.

Main Methods:

  • Post-hoc analysis of the HOPE-REAL study (NCT05520320) involving HOPE-treated brain-dead donor (DBD) livers.
  • Comparison with a control cohort of non-perfused DBD livers using propensity score matching.
  • Definition of cumulative liver age as donor age plus post-transplant graft survival.

Main Results:

  • HOPE-treated livers had a higher median cumulative liver age (69 vs. 61 years) but superior graft survival (log-rank P<0.001).
  • HOPE remained an independent predictor of cumulative liver age in multivariate analysis (P<0.001).

Conclusions:

  • HOPE treatment effectively mitigates risks of using elderly DBD livers, ensuring excellent long-term graft survival.
  • Broader adoption of HOPE can enhance utilization of older donor livers and expand the donor pool.