FRI-465 Impact of hypothermic oxygenated perfusion on very old liver graft issued from donors after circulatory death (>70 years) livers: insights from a belgian bi-centric experience
(2026) EASL Congress — Location: Barcelona (27.May.2026)
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- Background and aims: Liver graft recipients from donors after circulatory death (DCD) face an increased risk of complications such as primary non-function (PNF) and non-anastomotic biliary stricture(NAS). This is due to the warm ischemia time, inherent to the DCD procurement. Similarly, liver grafts from very old (>70 years) donors are known to increase these risks, although they represent a valuable option to safely increase the donor pool. Ex-situ end-ischemic hypothermic oxygenated perfusion (HOPE) of DCD-grafts <60 years has been demonstrated to reduce the incidence of complications following liver transplantation (LT). However, results of HOPE in grafts from very Old-DCD (>70 years) remains scarce. Therefore, we aim to study impact of HOPE on these specific grafts. Method: Data from 95 LT using >70 years DCD-graft, transplanted in 2 Belgian centres between 2015 and 2025 were collected. Of those, 53 were preserved with HOPE (Old-DCD-HOPE), and 42 were preserved in static cold storage (Old-DCD-SCS). Graft-related complications was defined as the occurrence of PNF, biliary complications, vascular complications, re-laparotomy within 10 days after LT and occurrence of renal replacement therapy after LT. Results: Recipient characteristics (indication, age, MELD score) and warm ischemia times were comparable between groups. HOPE-liver grafts were perfused for 172 minutes (mean), reducing static cold ischemia time to 216 minutes (mean) (compared to 332 minutes (mean), p < 0.001). Donors were older in the Old-DCD-HOPE (76.9 ± 5.7 years old) compared to the Old-DCD-SCS (73.5 ± 2.9 years old) (p < 0.001). Old-DCD-HOPE presented a lower rate of graft-related complications (0.57/patient) compared to Old-DCD-SCS (1.14/ patient) (p = 0.003), including NAS (5.7% vs 21.4%, p = 0.047), while graft-threatening complications (leading to re-LT or death) were reduced (7.5% vs 28.6%, p = 0.015). There was no difference in 1-year graft survival (84.0% vs. 76.0%, p = 0.238). Conclusion: These findings support that using of HOPE for DCD-graft >70 years results with fewer graft-related and graft-threatening complications. By enabling the safe transplantation of grafts from very old DCD donors, HOPE contributes to a meaningful expansion of donor availability. Larger prospective studies are required to confirm these encouraging results
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Bonaccorsi-Riani, E., Foguenne, M., Dubois, A., Blondeel, J., Marique, L., Channaoui, A., Ciccarelli, O., Coubeau, L., Dahlqvist, G., Vandevoorde, K., Degezelle, K., Sainz-Barriga, M., Jochmans, I., Pirenne, J., Monbaliu, D., & et al. (2026). FRI-465 Impact of hypothermic oxygenated perfusion on very old liver graft issued from donors after circulatory death (>70 years) livers: insights from a belgian bi-centric experience. Journal of Hepatology, 84, S381-S382. https://doi.org/10.1016/S0168-8278(26)01169-4 (Original work published 2026)