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

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 chara...

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Published in:	Clinical transplantation Vol. 31; no. 10
Main Authors:	Coffey, Jessica C., Wanis, Kerollos N., Monbaliu, Diethard, Gilbo, Nicholas, Selzner, Markus, Vachharajani, Neeta, Levstik, Mark A., Marquez, Max, Doyle, Maria B. Majella, Pirenne, Jacques, Grant, David, Heimbach, Julie K., Chapman, William, Vogt, Kelly, Hernandez‐Alejandro, Roberto
Format:	Journal Article Web Resource
Language:	English
Published:	Denmark Blackwell Publishing Ltd 01-10-2017
Subjects:	Adult age bile duct disease bile duct diseases/diagnostic imaging bile duct diseases/etiology bile duct diseases/pathology bile duct diseases/therapy bile leakage Chirurgie cholangiography cohort analysis cold ischemia Death donor Donor Selection Female follow up Follow-Up Studies graft failure graft recipient Graft Rejection Graft Rejection - etiology Graft Rejection - mortality Graft Rejection - pathology Graft Survival hemodynamic parameters hepatic artery thrombosis human Human health sciences Humans ischemia Liver Transplantation Liver Transplantation - adverse effects Liver Transplantation - mortality Male mean arterial pressure Middle Aged mortality organ donor outcome assessment oxygen saturation pathology portal vein thrombosis postoperative complication Postoperative Complications priority journal procedures Prognosis Retrospective Studies retrospective study risk factor Risk Factors Sciences de la santé humaine Surgery Tissue and Organ Procurement Tissue and Organ Procurement - methods Tissue Donors transplantation warm ischemia Warm Ischemia - adverse effects cholangiography liver transplantation/adverse effects bile duct diseases/therapy cold ischemia graft survival warm ischemia adult bile duct diseases/etiology bile duct diseases/diagnostic imaging bile duct diseases/pathology
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 scopus-id:2-s2.0-85030666306
ISSN:	0902-0063 1399-0012 1399-0012
DOI:	10.1111/ctr.13068