Pushing the Limit for Marginal Grafts in the Era of Machine Perfusion: A Tale of HOPE From a Leading Italian Institution.

IF 2.3 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2026-04-28 DOI:10.1111/aor.70137

Gerti Dajti, Giuliana Germinario, Enrico Prosperi, Guido Fallani, Chiara Bonatti, Edoardo Prosperi, Antonio Siniscalchi, Maria Cristina Morelli, Antonietta D' Errico, Matteo Serenari, Massimo Del Gaudio, Chiara Zanfi, Federica Odaldi, Lorenzo Maroni, Andrea Laurenzi, Matteo Cescon, Matteo Ravaioli

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引用次数: 0

Abstract

Background: The advent of machine perfusion (MP) has significantly improved post-liver transplantation (post-LT) outcomes, potentially enabling the use of increasingly marginal grafts and expanding the organ donor pool.

Methods: We present a retrospective cohort study of consecutive adult patients who underwent LT between 2018 and 2023 at a leading Italian institution. The objective was to evaluate outcomes following the use of hypothermic oxygenated perfusion (HOPE) in high-risk grafts.

Results: A total of 507 patients were included in the final analysis, of whom 420 (83%) received extended criteria donor (ECD) grafts. Among ECD grafts, 62 (15%) were from donation after circulatory death (DCD) donors, and 64 (15%) were previously discarded by other centers. HOPE was applied in 248 (49%) cases. Recipients in the HOPE group experienced significantly lower rates of early allograft dysfunction (EAD) (20% vs. 32%, p = 0.007), primary nonfunction (2% vs. 7%, p = 0.017), and severe postoperative complications (Clavien-Dindo grade ≥ 3b) (19% vs. 28%, p = 0.026). Notably, marginal grafts treated with HOPE achieved survival outcomes comparable to those of standard risk.

Conclusions: HOPE is associated with improved outcomes in LT using ECD grafts and can enable the safe use of higher-risk organs with acceptable results when performed in experienced centers.

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在机器灌注时代推动边缘移植的极限：来自意大利领先机构的希望故事。

背景：机器灌注（MP）的出现显著改善了肝移植后（lt后）的预后，可能使边缘移植的使用越来越多，并扩大了器官供体池。方法：我们对意大利一家领先机构2018年至2023年间连续接受肝移植的成年患者进行了回顾性队列研究。目的是评估在高风险移植物中使用低温氧灌注（HOPE）后的结果。结果：最终分析共纳入507例患者，其中420例（83%）接受扩展标准供体（ECD）移植。在ECD移植物中，62例（15%）来自循环死亡（DCD）供体后的捐赠，64例（15%）以前被其他中心丢弃。248例（49%）应用HOPE。HOPE组受者的早期异体移植物功能障碍（EAD）（20% vs. 32%, p = 0.007）、原发性无功能（2% vs. 7%, p = 0.017）和严重的术后并发症（Clavien-Dindo分级≥3b）（19% vs. 28%, p = 0.026）的发生率显著降低。值得注意的是，用HOPE治疗的边缘移植物获得了与标准风险相当的生存结果。结论：HOPE与使用ECD移植的LT预后改善有关，并且当在经验丰富的中心进行时，可以安全地使用高风险器官并获得可接受的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.