Impact of the donor hepatectomy time on short-term outcomes in liver transplantation using donation after circulatory death: A review of the US national registry.
Clin Transplant
; 36(9): e14778, 2022 09.
Article
em En
| MEDLINE
| ID: mdl-35866342
ABSTRACT
BACKGROUND:
During the donor hepatectomy time (dHT), defined as the time from the start of cold perfusion to the end of the hepatectomy, liver grafts have a suboptimal temperature. The aim of this study was to analyze the impact of prolonged dHT on outcomes in donation after circulatory death (DCD) liver transplantation (LT).METHODS:
Using the US national registry data between 2012 and 2020, DCD LT patients were separated into two groups based on their dHT standard dHT (< 42 min) and prolonged dHT (≥42 min).RESULTS:
There were 3810 DCD LTs during the study period. Median dHT was 32 min (interquartile range 25-41 min). Kaplan-Meier graft survival curves demonstrated inferior outcomes in the prolonged dHT group at 1-year after DCD LT compared to those in the standard dHT group (85.3% vs 89.9%; P < .01). Multivariate Cox proportional hazards models for 1-year graft survival identified that prolonged dHT [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.19 - 1.79], recipient age ≥ 64 years (HR 1.40, 95% CI 1.14 - 1.72), and MELD score ≥ 24 (HR 1.43, 95% CI 1.16 - 1.76) were significant predictors of 1-year graft loss. Spline analysis shows that the dHT effects on the risk for 1-year graft loss with an increase in the slope after median dHT of 32 min.CONCLUSION:
Prolonged dHTs significantly reduced graft and patient survival after DCD LT. Because dHT is a modifiable factor, donor surgeons should take on cases with caution by setting the dHT target of < 32 min.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Obtenção de Tecidos e Órgãos
/
Transplante de Fígado
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article