{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T02:10:19Z","timestamp":1769479819898,"version":"3.49.0"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Many advantages have been reported with the use of machine perfusion (MP) to rescue extended criteria donor (ECD) grafts, improving both short- and long-term post-liver transplantation (LT) outcomes. Acute kidney injury (AKI) is a common post-LT complication associated with these grafts and may compromise patient outcomes and increase LT-related costs. The aim of the study was to analyze the incidence of AKI in recipients of MP-treated grafts compared with those receiving conventionally cold-stored (SCS) grafts, both before and after a propensity score matching (PSM). From a prospectively maintained database, LT recipients of MP-treated grafts were compared with SCS grafts transplanted in the same study period (January 2022\u2013May 2025). PSM was performed based on donor risk index (DRI), macrosteatosis (\u2265 or &lt;30%), and recipient NaMELD score using a 3:1 (MP vs. SCS) ratio. Of the 177 consecutive LTs, 30 were performed with MP-treated grafts (MP group) and 147 using SCS (SCS group). The MP group displayed more marginal characteristics: older age (72 vs. 62 years, p = 0.02), higher proportion of DCD (10% vs. 0, p = 0.04), and higher frequency of moderate steatosis (macro \u2265 30%, 10% vs. 2.7%, p = 0.09). AKI rates were similar between groups (63% vs. 45.6%, p = 0.16), as was the distribution across AKI stages. After PSM, donor and recipient characteristics were balanced, and AKI rates remained similar between groups (58.6% vs. 47.1%, p = 0.39). Donor diabetes and recipient age were independent predictors of AKI in multivariate analysis (donor diabetes OR 3.29, 95% CI 1.347\u20138.030; recipient age: OR 1.06, 95% CI 1.015\u20131.097, both p &lt; 0.05). MCP-1 and TNF-\u03b1 levels measured in the perfusate fluid within the first minutes of perfusion were positively correlated with post-LT creatinine peak (MCP-1, p = 0.00023, R = 0.58; TNF-\u03b1, p = 0.0004, R = 0.57). In conclusion, machine perfusion remains a valuable strategy for rescuing ECD liver grafts. In the current era\u2014characterized by increasing use of machine-perfused grafts and extended criteria donors\u2014recipients demonstrate postoperative renal outcomes comparable to those receiving conventionally preserved grafts.<\/jats:p>","DOI":"10.3390\/ijms27031235","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T15:48:30Z","timestamp":1769442510000},"page":"1235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Kidney Injury Post-Liver Transplant Using Grafts Treated with Hypothermic Machine Perfusion: From Biology to Surgical Aspects"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-9311","authenticated-orcid":false,"given":"Irene","family":"Scalera","sequence":"first","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2898-8164","authenticated-orcid":false,"given":"Grazia","family":"Labellarte","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2898-6927","authenticated-orcid":false,"given":"Oronzo","family":"Ligurgo","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6915-9755","authenticated-orcid":false,"given":"Francesco","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"},{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluigi","family":"Gigante","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Roselli","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Filippa","family":"Valentini","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossana","family":"Franzin","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplant Department, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Stasi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplant Department, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loreto","family":"Gesualdo","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy"},{"name":"Nephrology, Dialysis and Transplant Department, University Hospital Policlinic of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3166-6684","authenticated-orcid":false,"given":"Francesco","family":"Tandoi","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, 70124 Bari, Italy"},{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/lt.24728","article-title":"Hepatic ischemia\/reperfusion injury associates with acute kidney injury in liver transplantation: Prospective cohort study","volume":"23","author":"Jochmans","year":"2017","journal-title":"Liver Transpl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1002\/lt.21951","article-title":"Effect of pretransplant serum creatinine on the survival benefit of liver transplantation","volume":"15","author":"Sharma","year":"2009","journal-title":"Liver Transpl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/j.transproceed.2014.05.053","article-title":"Acute kidney injury after 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