Effect of airplane transport of donor livers on post-liver transplantation survival.

AIM: To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS: A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression. RESULTS: One hundred and ninety-three patients received a local donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase (mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index (mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time (CIT) (mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance (r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss (HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver (P = 0.027). CONCLUSION: Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.

A risk score system to preoperatively predict TNM stages in gastric cancer.

BACKGROUND: To improve the estimation of tumor status and facilitate the stage-dependent treatment planning, we developed a reliable and easy-to-use risk score for prediction of tumor-node-metastasis stages in gastric cancer. METHODS: Clinicopathological data were collected prospectively from 108 curatively resected patients with gastric cancer. The risk score was established on the basis of independent predictive factors for tumor stages, and its performance was evaluated by receiver operating characteristic (ROC) analysis. RESULTS: The following 4 independent factors were included in our score: serum albumin levels, tumor size, T and N categories determined by helical computed tomography. Using ROC analysis, we chose a score at 7 as the optimal cut point for differentiating the more advanced disease (stage III/IV) from the less advanced one (stage I/II). With the defined cut point, our score allowed predicting stage III/IV with sensitivity of 79.6%, specificity of 85.2%, and accuracy of 82.4%. The discriminative ability of this score was good (the area under the ROC curve, 0.861-0.965). CONCLUSIONS: The risk score may be helpful to preoperative gastric cancer staging. It probably assists surgeons in deciding the extent of surgery and in choosing the appropriate perioperative adjuvant therapies.