The influence of functional warm ischemia time on DCD liver transplant recipients’ outcomes

adult; bile duct diseases/diagnostic imaging; bile duct diseases/etiology; bile duct diseases/pathology; bile duct diseases/therapy; cholangiography; cold ischemia; graft survival; liver transplantation/adverse effects; warm ischemia; Adult; Death; Donor Selection; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Tissue and Organ Procurement; Tissue Donors; Warm Ischemia; age; Article; bile duct disease; bile leakage; cohort analysis; female; graft failure; graft recipient; hemodynamic parameters; hepatic artery thrombosis; human; ischemia; liver transplantation; male; mean arterial pressure; organ donor; outcome assessment; oxygen saturation; portal vein thrombosis; postoperative complication; priority journal; retrospective study; death; donor; donor selection; follow up; graft rejection; middle aged; mortality; pathology; procedures; prognosis; risk factor; transplantation

Abstract :

[en] Background: Duration of functional warm ischemia (f-WIT) is thought to have a causal effect on outcomes in controlled donation after circulatory death (DCD) liver transplantation (LT). Methods: A retrospective cohort study was conducted at five centers. Data were extracted on donor and recipient characteristics, with attention to parameters recorded during withdrawal of life support to in situ cold perfusion. F-WIT was the time elapsed from any of the hemodynamic and oxygenation parameters to the start of in situ cold perfusion. Parameters were as follows: MAP ≤ 50 mm Hg; SBP ≤ 50 mm Hg; and SPO2 ≤ 60%. The primary endpoint was a composite of disseminated ischemic cholangiopathy (IC), primary non-function (PNF), and early graft failure. Results: 35 patients (14%) developed one or more of the primary outcomes. On univariate analysis, older donors and longer WITs were associated with greater likelihood of complications. Of the f-WIT variations analyzed, only f-WIT with SpO2 ≤ 60% was longer among patients with complications. On multivariate analysis, only donor age was a significant predictor of complications. Conclusion: This study demonstrates that, of the f-WITs, f-WIT with SpO2 ≤ 60% is most predictive of post-DCD complications. However, results suggest that there may be an alternate etiology for poor outcomes, and that donor age plays a key role. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Disciplines :

Surgery

Author, co-author :

Coffey, Jessica C; Division of General Surgery, Western University, London, ON, Canada

Wanis, Kerollos N; Division of General Surgery, Western University, London, ON, Canada

Monbaliu, Diethard; Abdominal Transplant Surgery, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven, Belgium

Gilbo, NICHOLAS ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation

Selzner, Markus; Department of Surgery, University of Toronto, Toronto, ON, Canada

Vachharajani, Neeta; Department of Surgery, Washington University, St. Louis, MO, United States

Levstik, Mark A; Division of Transplantation, University of Rochester, Rochester, NY, United States

Marquez, Max; Department of Surgery, University of Toronto, Toronto, ON, Canada

Doyle, Maria B Majella; Department of Surgery, Washington University, St. Louis, MO, United States

Pirenne, Jacques; Abdominal Transplant Surgery, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven, Belgium

More authors (5 more)

Language :

English

Title :

The influence of functional warm ischemia time on DCD liver transplant recipients’ outcomes

Publication date :

2017

Journal title :

Clinical Transplantation

ISSN :

0902-0063

eISSN :

1399-0012

Publisher :

Blackwell Publishing Ltd

Volume :

Issue :

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 25 January 2024

Statistics

Number of views

5 (0 by ULiège)

Number of downloads

1 (0 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

The U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. OPTN/SRTR Annual Report: Transplant Data 1998-2012.
Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant. 2006;6:791-796.
Lee KW, Simpkins CE, Montgomery RA, Locke JE, Segev DL, Maley WR. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation. 2006;82:1683-1688.
Jay CL, Lyuksemburg V, Ladner DP, et al. Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta-analysis. Ann Surg. 2011;253:259-264.
Foley DP, Fernandez LA, Leverson G, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242:724-731.
Chan EY, Olson LC, Kisthard JA, et al. Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl. 2008;14:604-610.
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:783-790.
Dutkowski P, Schlegel A, Slankamenac K, et al. The use of fatty liver grafts in modern allocation systems: risk assessment by the Balance of Risk (BAR) score. Ann Surg. 2012;256:861-869.
Abt P, Praestgaard J, West S, Hasz R. Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation. Liver Transpl. 2014;20:165-172.
Rhee JY, Alroy J, Freeman RB. Characterization of the withdrawal phase in a porcine donation after the cardiac death model. Am J Transplant. 2011;11:1169-1175.
Ho KJ, Owens CD, Johnson SR, et al. Donor postextubation hypotension and age correlate with outcome after donation after cardiac death transplantation. Transplantation. 2008;85:1588-1594.
Taner CB, Bulatao IG, Perry DK, et al. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int. 2012;25:838-846.
Thuluvath PJ, Guidinger MK, Fung JJ, Johnson LB, Rayhill SC, Pelletier SJ. Liver transplantation in the United States, 1999-2008. Am J Transplant. 2010;10:1003-1019.
McCormack L, Petrowsky H, Jochum W, Mullhaupt B, Weber M, Clavien PA. Use of severely steatotic grafts in liver transplantation: a matched case-control study. Ann Surg. 2007;246:940-946.
Hong JC, Yersiz H, Kositamongkol P, et al. Liver transplantation using organ donation after cardiac death: a clinical predictive index for graft failure-free survival. Arch Surg. 2011;146:1017-1023.
Tariciotti L, Rocha C, Perera MT, et al. Is it time to extend liver acceptance criteria for controlled donors after cardiac death? Transplantation. 2011;92:1140-1146.
Rutherford K. Principles and application of oximetry. Crit Care Nurs Clin North Am. 1989;1:649-657.
Gilbo N, Jochmans I, Sainz M, Pirenne J, Meurisse N, Monbaliu D. Reducing non-anastomotic biliary strictures in donation after circulatory death liver transplantation: cold ichemia time matters! Ann Surg. 2017. https://doi.org/10.1097/SLA.0000000000001949.