TY - JOUR
T1 - The influence of functional warm ischemia time on DCD liver transplant recipients’ outcomes
AU - Coffey, Jessica C.
AU - Wanis, Kerollos N.
AU - Monbaliu, Diethard
AU - Gilbo, Nicholas
AU - Selzner, Markus
AU - Vachharajani, Neeta
AU - Levstik, Mark A.
AU - Marquez, Max
AU - Doyle, Maria B.Majella
AU - Pirenne, Jacques
AU - Grant, David
AU - Heimbach, Julie K.
AU - Chapman, William
AU - Vogt, Kelly
AU - Hernandez-Alejandro, Roberto
N1 - Publisher Copyright:
© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - adult
KW - bile duct diseases/diagnostic imaging
KW - bile duct diseases/etiology
KW - bile duct diseases/pathology
KW - bile duct diseases/therapy
KW - cholangiography
KW - cold ischemia
KW - graft survival
KW - liver transplantation/adverse effects
KW - warm ischemia
UR - http://www.scopus.com/inward/record.url?scp=85030666306&partnerID=8YFLogxK
U2 - 10.1111/ctr.13068
DO - 10.1111/ctr.13068
M3 - Article
C2 - 28772351
AN - SCOPUS:85030666306
SN - 0902-0063
VL - 31
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 10
M1 - e13068
ER -