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

• 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
• DOI: 10.1111/ctr.13068
• EISSN: 1399-0012
• ISSN: 0902-0063; 1399-0012

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.