{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:54:39Z","timestamp":1791201279881,"version":"4.2.0"},"reference-count":66,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Organ shortage is a major barrier to transplantation, leading to the emergence of marginal donor organs and extended criteria donor grafts and, alongside these, machine perfusion as a platform for reconditioning grafts to meet transplantation standards. Despite functioning as a reconditioning platform in its own right, machine perfusion also allows for the delivery of therapeutic agents directly to grafts prior to transplant. Cell-based and cell-derived therapies have been increasingly explored for delivery during this window, although evidence is fragmented across individual organ systems, and whether ex vivo benefit is confirmed post-transplant remains unclear. This systematic review aimed to synthesise the evidence from both perfusion-phase findings and post-transplant findings across solid organ machine perfusion, evaluating the concordance between the two. Methods: This review was prospectively registered on PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Included studies delivered cell-based or cell-derived therapies during ex vivo machine perfusion of a solid organ. The SYRCLE tool was used across all studies to assess risk of bias, and given substantial heterogeneity in cell type, protocol, and organ models, findings were synthesised narratively, with a sensitivity analysis restricted to the subset of studies incorporating a transplantation phase. Results: Thirty-one studies met inclusion criteria, spanning kidney (n = 10), liver (n = 11), lung (n = 9), and heart (n = 1). Mechanisms converged largely on immunomodulatory and metabolic pathways, most consistently reported across organs, alongside a less consistent but notable cross-organ parallel in regenerative progenitor activation between liver and kidney. Benefit was reported more consistently at the molecular and histological levels rather than the physiological level. Eight of the studies proceeded to transplantation, of which half showed a beneficial post-transplant result, and half showed mixed results. Conclusions: Cell-based and cell-derived therapies are best understood as adjuncts to the existing reconditioning capacity of machine perfusion. Molecular and mechanistic benefit was consistently reported; however, confirmation beyond the perfusion phase remained incomplete across organ systems. Mechanisms supported by direct interventional evidence represent priority candidates for further preclinical validation and independent replication.<\/jats:p>","DOI":"10.3390\/jcm15197698","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:57:46Z","timestamp":1791197866000},"page":"7698","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cell-Based and Cell-Derived Therapies Delivered During Ex Vivo Machine Perfusion for Solid Organ Reconditioning Prior to Transplantation: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1498-2825","authenticated-orcid":false,"given":"Mariam","family":"Alemi","sequence":"first","affiliation":[{"name":"Imperial College London, South Kensington Campus, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5769-5504","authenticated-orcid":false,"given":"Zara","family":"Edwards","sequence":"additional","affiliation":[{"name":"Imperial College London, South Kensington Campus, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassilios","family":"Papalois","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e70095","DOI":"10.1002\/ctm2.70095","article-title":"Dynamic Conditioning of Porcine Kidney Grafts with Extracellular Vesicles Derived from Urine Progenitor Cells: A Proof-of-concept Study","volume":"14","author":"Burdeyron","year":"2024","journal-title":"Clin. Transl. Med."},{"key":"ref_2","unstructured":"NHS Blood and Transplant (2026, July 15). Organ Transplant Waiting List Hits Record High as Donor and Transplant Numbers Fall. Available online: https:\/\/www.organdonation.nhs.uk\/get-involved\/news\/organ-transplant-waiting-list-hits-record-high-as-donor-and-transplant-numbers-fall."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Patel, K., Brotherton, A., Chaudhry, D., Evison, F., Nieto, T., Dabare, D., and Sharif, A. (2023). All Expanded Criteria Donor Kidneys Are Equal But Are Some More Equal Than Others? A Population-Cohort Analysis of UK Transplant Registry Data. Transpl. Int., 36.","DOI":"10.3389\/ti.2023.11421"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Abbas, S.H., Ceresa, C.D.L., and Pollok, J.-M. (2024). Steatotic Donor Transplant Livers: Preservation Strategies to Mitigate against Ischaemia-Reperfusion Injury. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094648"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kvietkauskas, M., Leber, B., Strupas, K., Stiegler, P., and Schemmer, P. (2020). Machine Perfusion of Extended Criteria Donor Organs: Immunological Aspects. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00192"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E308","DOI":"10.1111\/aor.13499","article-title":"Dissemination of a Novel Organ Perfusion Technique: Ex Vivo Normothermic Perfusion of Deceased Donor Kidneys","volume":"43","author":"Chandak","year":"2019","journal-title":"Artif. Organs"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Iske, J., Schroeter, A., Knoedler, S., Nazari-Shafti, T.Z., Wert, L., Roesel, M.J., Hennig, F., Niehaus, A., Kuehn, C., and Ius, F. (2023). Pushing the Boundaries of Innovation: The Potential of Ex Vivo Organ Perfusion from an Interdisciplinary Point of View. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1272945"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e16244","DOI":"10.1111\/liv.16244","article-title":"Viability Assessment During Normothermic Machine Liver Perfusion: A Literature Review","volume":"45","author":"Jeddou","year":"2025","journal-title":"Liver Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/TP.0000000000004573","article-title":"Normothermic Machine Perfusion Systems: Where Do We Go From Here?","volume":"108","author":"Santamaria","year":"2024","journal-title":"Transplantation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1111\/ajt.13708","article-title":"Liver Transplantation After Ex Vivo Normothermic Machine Preservation: A Phase 1 (First-in-Man) Clinical Trial","volume":"16","author":"Ravikumar","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"for the Consortium for Organ Preservation in Europe, Nasralla, D., Coussios, C.C., Mergental, H., Akhtar, M.Z., Butler, A.J., Ceresa, C.D.L., Chiocchia, V., Dutton, S.J., and Garc\u00eda-Valdecasas, J.C. (2018). A Randomized Trial of Normothermic Preservation in Liver Transplantation. Nature, 557, 50\u201356.","DOI":"10.1038\/s41586-018-0047-9"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1111\/tri.13980","article-title":"Human Liver Stem Cell-derived Extracellular Vesicles Reduce Injury in a Model of Normothermic Machine Perfusion of Rat Livers Previously Exposed to a Prolonged Warm Ischemia","volume":"34","author":"Roggio","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wagner, M.J., Hatami, S., and Freed, D.H. (2023). Thoracic Organ Machine Perfusion: A Review of Concepts with a Focus on Reconditioning Therapies. Front. Transplant., 2.","DOI":"10.3389\/frtra.2023.1060992"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Dengu, F., Abbas, S.H., Ebeling, G., and Nasralla, D. (2020). Normothermic Machine Perfusion (NMP) of the Liver as a Platform for Therapeutic Interventions during Ex-Vivo Liver Preservation: A Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041046"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1961","DOI":"10.1097\/TXD.0000000000001961","article-title":"From Preservation to Repair: A Systematic Review of Therapeutic Organ Rehabilitation During Normothermic Ex Vivo Machine Perfusion","volume":"12","author":"Raza","year":"2026","journal-title":"Transplant. Direct"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6883","DOI":"10.1038\/s41467-025-60410-3","article-title":"Opportunities and Challenges with the Implementation of Normothermic Machine Perfusion in Kidney Transplantation","volume":"16","author":"Rabelink","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3381","DOI":"10.1111\/jcmm.13249","article-title":"Perfusion of Isolated Rat Kidney with Mesenchymal Stromal Cells\/Extracellular Vesicles Prevents Ischaemic Injury","volume":"21","author":"Gregorini","year":"2017","journal-title":"J. Cell. Mol. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1479-5876-9-51","article-title":"Adipose-Derived Mesenchymal Stem Cell Protects Kidneys against Ischemia-Reperfusion Injury through Suppressing Oxidative Stress and Inflammatory Reaction","volume":"9","author":"Chen","year":"2011","journal-title":"J. Transl. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/TP.0000000000001879","article-title":"Mesenchymal Stromal Cell Therapy for Solid Organ Transplantation","volume":"102","author":"Reinders","year":"2018","journal-title":"Transplantation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1093\/ndt\/gfs556","article-title":"Mesenchymal Stem Cells and Kidney Repair","volume":"28","author":"Morigi","year":"2013","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s10157-012-0614-6","article-title":"Effects of Adipose-Derived Mesenchymal Cells on Ischemia\u2013Reperfusion Injury in Kidney","volume":"16","author":"Furuichi","year":"2012","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Laing, R.W., Stubblefield, S., Wallace, L., Roobrouck, V.D., Bhogal, R.H., Schlegel, A., Boteon, Y.L., Reynolds, G.M., Ting, A.E., and Mirza, D.F. (2020). The Delivery of Multipotent Adult Progenitor Cells to Extended Criteria Human Donor Livers Using Normothermic Machine Perfusion. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.01226"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1111\/ajt.16100","article-title":"Novel Delivery of Cellular Therapy to Reduce Ischemia Reperfusion Injury in Kidney Transplantation","volume":"21","author":"Thompson","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1111\/ajt.16473","article-title":"Mesenchymal Stromal Cell Treatment of Donor Kidneys during Ex Vivo Normothermic Machine Perfusion: A Porcine Renal Autotransplantation Study","volume":"21","author":"Lohmann","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Pool, M., Eertman, T., Sierra Parraga, J., \u2019T Hart, N., Roemeling-van Rhijn, M., Eijken, M., Jespersen, B., Reinders, M., Hoogduijn, M., and Ploeg, R. (2019). Infusing Mesenchymal Stromal Cells into Porcine Kidneys during Normothermic Machine Perfusion: Intact MSCs Can Be Traced and Localised to Glomeruli. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143607"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/s41419-022-05034-x","article-title":"Mesenchymal Stem Cell-Derived Extracellular Vesicles for Immunomodulation and Regeneration: A next Generation Therapeutic Tool?","volume":"13","author":"Kou","year":"2022","journal-title":"Cell Death Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1080\/08820139.2020.1712416","article-title":"Mesenchymal Stem Cell-Derived Extracellular Vesicles: A Novel Cell-Free Therapy","volume":"49","author":"Jafarinia","year":"2020","journal-title":"Immunol. Investig."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1111\/ajt.17161","article-title":"The Current Status of Stem Cell-Based Therapies during Ex Vivo Graft Perfusion: An Integrated Review of Four Organs","volume":"22","author":"Luijmes","year":"2022","journal-title":"Am. J. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1159\/000552604","article-title":"From Preservation to Regeneration: Stem Cell-Derived Therapies in Machine-Perfused Kidney Transplants\u2013A Systematic Review and Meta-Analysis","volume":"51","author":"Navez","year":"2026","journal-title":"Kidney Blood Press. Res."},{"key":"ref_30","first-page":"e30982","article-title":"Classic and Current Opinions in Human Organ and Tissue Transplantation","volume":"14","author":"Oli","year":"2022","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1111\/ajt.17164","article-title":"De Novo SIX2 Activation in Human Kidneys Treated with Neonatal Kidney Stem\/Progenitor Cells","volume":"22","author":"Arcolino","year":"2022","journal-title":"Am. J. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Garreta, E., Moya-Rull, D., Centeno, A., Marco, A., Ullate-Agote, A., Amato, G., Aranda, C.J., Oria, R., Lozano-Ojalvo, D., and Pool, M.B.F. (2025). Systematic Production of Human Kidney Organoids for Transplantation in Porcine Kidneys during Ex Vivo Machine Perfusion. Nat. Biomed. Eng.","DOI":"10.1038\/s41551-025-01542-1"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Grignano, M.A., Bruno, S., Viglio, S., Avanzini, M.A., Tapparo, M., Ramus, M., Croce, S., Valsecchi, C., Pattonieri, E.F., and Ceccarelli, G. (2022). CD73-Adenosinergic Axis Mediates the Protective Effect of Extracellular Vesicles Derived from Mesenchymal Stromal Cells on Ischemic Renal Damage in a Rat Model of Donation after Circulatory Death. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231810681"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1089\/scd.2020.0024","article-title":"Treating Ischemically Damaged Porcine Kidneys with Human Bone Marrow- and Adipose Tissue-Derived Mesenchymal Stromal Cells During Ex Vivo Normothermic Machine Perfusion","volume":"29","author":"Pool","year":"2020","journal-title":"Stem Cells Dev."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Rampino, T., Gregorini, M., Germinario, G., Pattonieri, E.F., Erasmi, F., Grignano, M.A., Bruno, S., Alomari, E., Bettati, S., and Asti, A. (2022). Extracellular Vesicles Derived from Mesenchymal Stromal Cells Delivered during Hypothermic Oxygenated Machine Perfusion Repair Ischemic\/Reperfusion Damage of Kidneys from Extended Criteria Donors. Biology, 11.","DOI":"10.3390\/biology11030350"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Vallant, N., Wolfhagen, N., Sandhu, B., Hamaoui, K., and Papalois, V. (2024). Delivery of Mesenchymal Stem Cells during Hypothermic Machine Perfusion in a Translational Kidney Perfusion Study. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25095038"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1186\/s13287-021-02647-5","article-title":"HO-1\/BMMSC Perfusion Using a Normothermic Machine Perfusion System Reduces the Acute Rejection of DCD Liver Transplantation by Regulating NKT Cell Co-Inhibitory Receptors in Rats","volume":"12","author":"Cao","year":"2021","journal-title":"Stem Cell Res. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1038\/s41467-024-55217-7","article-title":"A Proof-of-Concept Study in Small and Large Animal Models for Coupling Liver Normothermic Machine Perfusion with Mesenchymal Stromal Cell Bioreactors","volume":"16","author":"Cillo","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e205","DOI":"10.1097\/TP.0000000000002123","article-title":"Extracellular Vesicles from Human Liver Stem Cells Reduce Injury in an Ex Vivo Normothermic Hypoxic Rat Liver Perfusion Model","volume":"102","author":"Rigo","year":"2018","journal-title":"Transplantation"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1126\/science.aaz6964","article-title":"Cholangiocyte Organoids Can Repair Bile Ducts after Transplantation in the Human Liver","volume":"371","author":"Sampaziotis","year":"2021","journal-title":"Science"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e930258-1\u2013e930258-13","DOI":"10.12659\/MSM.930258","article-title":"Protective Effects of Bone Marrow Mesenchymal Stem Cells (BMMSCS) Combined with Normothermic Machine Perfusion on Liver Grafts Donated After Circulatory Death via Reducing the Ferroptosis of Hepatocytes","volume":"27","author":"Sun","year":"2021","journal-title":"Med. Sci. Monit."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9935370","DOI":"10.1155\/2021\/9935370","article-title":"Heme Oxygenase-1-Modified Bone Marrow Mesenchymal Stem Cells Combined with Normothermic Machine Perfusion Repairs Bile Duct Injury in a Rat Model of DCD Liver Transplantation via Activation of Peribiliary Glands through the Wnt Pathway","volume":"2021","author":"Tian","year":"2021","journal-title":"Stem Cells Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"108643","DOI":"10.1016\/j.intimp.2022.108643","article-title":"Bone Marrow Mesenchymal Stem Cells Modified with Heme Oxygenase-1 Alleviate Rejection of Donation after Circulatory Death Liver Transplantation by Inhibiting Dendritic Cell Maturation in Rats","volume":"107","author":"Wu","year":"2022","journal-title":"Int. Immunopharmacol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1089\/scd.2019.0301","article-title":"Normothermic Machine Perfusion Combined with Bone Marrow Mesenchymal Stem Cells Improves the Oxidative Stress Response and Mitochondrial Function in Rat Donation After Circulatory Death Livers","volume":"29","author":"Yang","year":"2020","journal-title":"Stem Cells Dev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00441-020-03202-z","article-title":"Bone Marrow Mesenchymal Stem Cells Combine with Normothermic Machine Perfusion to Improve Rat Donor Liver Quality\u2014The Important Role of Hepatic Microcirculation in Donation after Circulatory Death","volume":"381","author":"Yang","year":"2020","journal-title":"Cell Tissue Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.healun.2024.08.014","article-title":"Amniotic Fluid-Derived Mesenchymal Stem Cells Reduce Inflammation and Improve Lung Function Following Transplantation in a Porcine Model","volume":"43","author":"Niroomand","year":"2024","journal-title":"J. Heart Lung Transplant."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.healun.2019.08.016","article-title":"Mesenchymal Stem Cell\u2013Derived Extracellular Vesicles Improve the Molecular Phenotype of Isolated Rat Lungs during Ischemia\/Reperfusion Injury","volume":"38","author":"Lonati","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s13287-017-0603-5","article-title":"Immunoregulatory Effects of Multipotent Adult Progenitor Cells in a Porcine Ex Vivo Lung Perfusion Model","volume":"8","author":"Martens","year":"2017","journal-title":"Stem Cell Res. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"L809","DOI":"10.1152\/ajplung.00358.2013","article-title":"Clinical Grade Allogeneic Human Mesenchymal Stem Cells Restore Alveolar Fluid Clearance in Human Lungs Rejected for Transplantation","volume":"306","author":"McAuley","year":"2014","journal-title":"Am. J. Physiol.-Lung Cell. Mol. Physiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.healun.2016.04.017","article-title":"Mesenchymal Stem Cell Treatment Is Associated with Decreased Perfusate Concentration of Interleukin-8 during Ex Vivo Perfusion of Donor Lungs after 18-Hour Preservation","volume":"35","author":"Mordant","year":"2016","journal-title":"J. Heart Lung Transplant."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.healun.2019.07.006","article-title":"Mesenchymal Stromal Cell Therapy during Ex Vivo Lung Perfusion Ameliorates Ischemia-Reperfusion Injury in Lung Transplantation","volume":"38","author":"Nakajima","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.omtm.2021.05.018","article-title":"Engineered Mesenchymal Stromal Cell Therapy during Human Lung Ex Vivo Lung Perfusion Is Compromised by Acidic Lung Microenvironment","volume":"23","author":"Mariscal","year":"2021","journal-title":"Mol. Ther.-Methods Clin. Dev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.healun.2025.03.018","article-title":"Preconditioning Donor Lungs with Lung-Derived Exosomes Mitigates Ischemia-Reperfusion Injury in a Warm Ischemia Porcine DCD Model","volume":"44","author":"Ribeiro","year":"2025","journal-title":"J. Heart Lung Transplant."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s12931-017-0704-9","article-title":"Mesenchymal Stromal Cell-Derived Extracellular Vesicles Attenuate Lung Ischemia-Reperfusion Injury and Enhance Reconditioning of Donor Lungs after Circulatory Death","volume":"18","author":"Stone","year":"2017","journal-title":"Respir. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1097\/TP.0000000000005040","article-title":"Normothermic Ex Vivo Heart Perfusion With Exosomes From Human Umbilical Cord Mesenchymal Stem Cells Improves Graft Function in Donation After Circulatory Death Hearts","volume":"108","author":"Zhang","year":"2024","journal-title":"Transplantation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3282","DOI":"10.1111\/ajt.13906","article-title":"Successful Transplantation of Human Kidneys Deemed Untransplantable but Resuscitated by Ex Vivo Normothermic Machine Perfusion","volume":"16","author":"Hosgood","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1056\/NEJMoa1014597","article-title":"Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation","volume":"364","author":"Cypel","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2939","DOI":"10.1038\/s41467-020-16251-3","article-title":"Transplantation of Discarded Livers Following Viability Testing with Normothermic Machine Perfusion","volume":"11","author":"Mergental","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jchf.2023.11.015","article-title":"Increasing Utilization of Extended Criteria Donor Hearts for Transplantation","volume":"12","author":"Schroder","year":"2024","journal-title":"JACC Heart Fail."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s10047-026-01550-1","article-title":"Technical Challenges and Prospects for Ex Vivo Heart Perfusion: A Republication of the Review Published in Japanese Journal of Artificial Organs","volume":"29","author":"Sakota","year":"2026","journal-title":"J. Artif. Organs"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"109922","DOI":"10.1016\/j.compbiomed.2025.109922","article-title":"Evaluating Cardiac Function in Ex Vivo Heart Perfusion Using Lumped Parameter Models","volume":"189","author":"Roig","year":"2025","journal-title":"Comput. Biol. Med."},{"key":"ref_62","first-page":"MR000033","article-title":"Industry Sponsorship and Research Outcome","volume":"2017","author":"Lundh","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1002\/hep.30871","article-title":"Peribiliary Gland Niche Participates in Biliary Tree Regeneration in Mouse and in Human Primary Sclerosing Cholangitis","volume":"71","author":"Carpino","year":"2020","journal-title":"Hepatology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3658013","DOI":"10.1155\/2016\/3658013","article-title":"Stem\/Progenitor Cell Niches Involved in Hepatic and Biliary Regeneration","volume":"2016","author":"Carpino","year":"2016","journal-title":"Stem Cells Int."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1002\/hep.30365","article-title":"Peribiliary Glands Are Key in Regeneration of the Human Biliary Epithelium After Severe Bile Duct Injury","volume":"69","author":"Matton","year":"2019","journal-title":"Hepatology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7698\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:13:15Z","timestamp":1791198795000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":66,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197698"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197698","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]}}}