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Observational Study
. 2025 Nov 1;282(5):765-771.
doi: 10.1097/SLA.0000000000006883. Epub 2025 Aug 7.

Life Expectancy of Transplanted Livers: HOPE Against Aging?

Janina Eden  1   2   3 , Philip C Müller  3 , Christoph Kuemmerli  3 , Noa Aegerter  3 , Isabel M A Brüggenwirth  1   2 , Gabriela Berlakovich  4 , Bettina M Buchholz  5 , Florin Botea  6 , Stefania Camagni  7 , Matteo Cescon  8 , Umberto Cillo  9 , Fabio Colli  10 , Luciano G De Carlis  11 , Riccardo De Carlis  11 , Fabrizio Di Benedetto  12 , Jule Dingfelder  4 , Dulce Diogo  13 , Daniele Dondossola  14 , Moritz Drefs  15 , Jiri Fronek  16 , Giuliana Germinario  8 , Enrico Gringeri  9 , Christiano Guidetti  12 , Georg Györi  4 , Matej Kocik  17 , Efrayim H Küçükerbil  17 , Dionysios Koliogiannis  15 , Georg Lurje  18 , Paolo Magistri  12 , Diethard Monbaliu  19 , Mostafa El Moumni  20 , Beat Müller  3 , Damiano Patrono  10 , Wojciech G Polak  17 , Robert J Porte  2   17 , Matteo Ravaioli  8 , Michel Rayar  21 , Renato Romagnoli  10 , Gustaf Sörensen  22 , Deniz Uluk  18 , Pierre A Clavien  23 , Vincent E de Meijer  1   2 , Philipp Dutkowski  3   23
Affiliations
Observational Study

Life Expectancy of Transplanted Livers: HOPE Against Aging?

Janina Eden et al. Ann Surg. .

Abstract

Objective: To investigate the impact of cumulative liver age on graft survival in liver transplant recipients.

Background: 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 seems 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.

Keywords: cumulative liver age; liver transplantation; machine liver perfusion.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Distribution (scatter plot) of cumulative liver age throughout the observation periods in both cohorts. The number of cases during different observation periods, that is, 1986 to 2022 and 2015 to 2022 (A), and by liver age (B) is shown for the HOPE group and the control group, along with the median cumulative liver age (C) for each group.
FIGURE 2
FIGURE 2
Univariate (A) and multivariate (B) analysis for cumulative liver age between the control group and the HOPE group. C, Comparison of the proportion of transplanted livers with donor age older than 80 years to the proportion of the aged European population (>80 years). (Source: Statistica 2020, URL: https://www.statista.com/statistics/1235624/share-of-elderly-population-in-europe-by-country/).
FIGURE 3
FIGURE 3
Cumulative liver age in relation to survival probability after propensity score matching in the HOPE group versus the control group (A), with key confounders adjusted in both cohorts (B).
See this image and copyright information in PMC

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