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Title: | The Impact of Hepatectomy Time of the Liver Graft on Post-transplant Outcome A Eurotransplant Cohort Study | Authors: | Jochmans, Ina FIEUWS, Steffen Tieken, Ineke Samuel, Undine Pirenne, Jacques |
Issue Date: | 2019 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | ANNALS OF SURGERY, 269(4), p. 712-717 | Abstract: | Objective: Assessing the effect of donor hepatectomy time on outcome after transplantation. Summary of Background Data: When blood supply in a deceased organ donor stops, ischemic injury starts. Livers are cooled to reduce cellular metabolism and minimize ischemic injury. This cooling is slow and livers are lukewarm during hepatectomy, potentially affecting outcome. Methods: We used the Eurotransplant Registry to investigate the relationship between donor hepatectomy time and post-transplant outcome in 12,974 recipients of deceased-donor livers (January 1, 2004, to December 31, 2013). Cox regression analyses for patient and graft survival (censored and uncensored for death with a functioning graft) were corrected for donor, preservation, and recipient variables. Donor hepatectomy time was defined as time between start of aortic cold flush and placement of the liver in the ice-bowl. Results: Median donor hepatectomy time was 41 minutes [interquartile range (IQR) 32 to 52]. Livers donated after circulatory death had longer hepatectomy times than those from brain-dead donors [50 minutes (35 to 68) vs 40 minutes (32 to 51), P < 0.001]. Donor hepatectomy time was independently associated with graft loss [adjusted hazard ratio (HR) 1.03 for every 10-minute increase, 95% confidence interval (95% CI) 1.02-1.05; P < 0.001]. The magnitude of this effect was comparable to the effect of each hour of additional cold ischemia time (adjusted HR 1.04, 95% CI 1.02-1.05; P < 0.001). Donor hepatectomy time had a similar effect on death-censored graft survival and patient survival. Livers donated after circulatory death and those with a higher donor risk index were more susceptible to the effect of donor hepatectomy time on death-censored graft survival. Conclusion: Donor hepatectomy time impairs liver transplant outcome. Keeping this time short together with efficient cooling during hepatectomy might improve outcome. | Notes: | [Jochmans, Ina; Pirenne, Jacques] Katholieke Univ Leuven, Lab Abdominal Transplant Surg, Dept Microbiol & Immunol, Leuven, Belgium. [Jochmans, Ina; Pirenne, Jacques] Univ Hosp Leuven, Abdominal Transplant Surg, Herestr 49, B-3000 Leuven, Belgium. [Fieuws, Steffen] Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, I BioStat, Leuven, Belgium. [Tieken, Ineke; Samuel, Undine] Univ Hasselt, Leuven, Belgium. [Tieken, Ineke; Samuel, Undine] Eurotransplant Int Fdn, Leiden, Netherlands. | Keywords: | donor hepatectomy time; extraction time; graft survival; liver transplantation; organ donation; patient survival; registry analysis; transplant outcome;Surgery | Document URI: | http://hdl.handle.net/1942/30040 | ISSN: | 0003-4932 | e-ISSN: | 1528-1140 | DOI: | 10.1097/SLA.0000000000002593 | ISI #: | 000467459700034 | Rights: | 2019 Ovid Technologies, Inc., and its partners and affiliates. All Rights Reserved. Some content from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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