{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:05:49Z","timestamp":1784883949830,"version":"3.55.0"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The advent of machine perfusion (MP) has significantly improved post\u2010liver transplantation (post\u2010LT) outcomes, potentially enabling the use of increasingly marginal grafts and expanding the organ donor pool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010risk grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), primary nonfunction (2% vs. 7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), and severe postoperative complications (Clavien\u2013Dindo grade \u2265\u20093b) (19% vs. 28%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026). Notably, marginal grafts treated with HOPE achieved survival outcomes comparable to those of standard risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HOPE is associated with improved outcomes in LT using ECD grafts and can enable the safe use of higher\u2010risk organs with acceptable results when performed in experienced centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70137","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:51:51Z","timestamp":1777431111000},"page":"1027-1036","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pushing the Limit for Marginal Grafts in the Era of Machine Perfusion: A Tale of HOPE From a Leading Italian Institution"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3074-4524","authenticated-orcid":false,"given":"Gerti","family":"Dajti","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"},{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-1956","authenticated-orcid":false,"given":"Giuliana","family":"Germinario","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9389-1812","authenticated-orcid":false,"given":"Enrico","family":"Prosperi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"},{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5774-7696","authenticated-orcid":false,"given":"Guido","family":"Fallani","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"},{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4203-7824","authenticated-orcid":false,"given":"Chiara","family":"Bonatti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"},{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna 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