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.

Background: 25 to 50% of patients suffering from colorectal cancer develop liver metastases. The incidence of regional lymph node (LN) metastases within the liver is up to 14%. The need for perihilar lymph node dissection (LND) is still a controversial topic in patients with colorectal liver metastases (CRLM). This study investigates the role of perihilar LND in patients with CRLM. Methods: For this retrospective study, patients undergoing surgery for CRLM at the University Hospital Basel between May 2009 and December 2021 were included. In patients with perihilar LND, LN were stained for CK22 and examined for single tumour cells (2 mm). Results: 112 patients undergoing surgery for CRLM were included. 54 patients underwent LND, 58/112 underwent liver resection only (LR). 3/54 (5.6%) showed perihilar LN metastases in preoperative imaging, and in 10/54 (18.5%), micro-metastases could be proven after CK22 staining. Overall complications were similar in both groups (LND: 46, 85.2%; LR: 48, 79.3%; p = 0.800). The rate of major complications was higher in the LND group (LND: 22, 40.7%; LR: 18, 31%, p = 0.002). Median recurrence-free survival (RFS) (LND: 10 months; LR: 15 months, p = 0.076) and overall survival (OS) were similar (LND: 49 months; LR: 60 months, p = 0.959). Conclusion: Preoperative imaging is not sensitive enough to detect perihilar LN metastases. Perihilar LND enables precise tumour staging by detecting more lymph node metastases, especially through CK22 staining. However, perihilar LND does not influence oncologic outcomes in patients with CRLM.