During donor hepatectomy, despite topic cooling to 10-20[deg]C, the liver still sustains warm ischemia that might be harmful.

We investigated the relationship between extraction time (ET) and transplant survival in 12974 recipients of deceased-donor livers transplanted in Eurotransplant (2004-2013). Cox regression analyses were corrected for donor, preservation, recipient variables. Transplant center was included as random effect (stronger impact on outcome than donor center). ET was the time from start of cold flush and end of hepatectomy. Transplant survival was defined as all-cause graft failure.

Median follow-up was 4.04y (IQR 2.4-6.2). Median ET was 41 min (32-52). ET was longer in livers donated after circulatory death (DCD) compared to brain-dead donors [50min (35-68) vs 40min (32-51), p<0.001]. ET independently associated with transplant loss (adjusted hazard ratio 1.03 for every 10min increase, 95%CI 1.02-1.05; p<0.0001). Other independent risk factor were donor/recipient age, donor last sodium/peak AST, DCD, split liver, cold ischemia time, lab MELD, acute liver failure, retransplant, cholestatic disease, viral hepatitis, recipient BMI. The magnitude of ET-effect was comparable to the effect of each hour of additional cold ischemia time (adjusted hazard ratio 1.04, 95%CI 1.02-1.05; p<0.0001). The form of the relation between ET and risk did not suggest a clear cut-off after which risk for transplant loss increases exponentially. Fig.1 depicts the probability for transplant loss within 3mo in this cohort as a function of ET: the clinical effect of prolonged ET is moderate at most. Increased risk for transplant loss in DCDs could be attributed to donor warm ischemia. There was no evidence that DCD livers are more susceptible to ET (no interaction between ET and DCD status), but there were only 461 DCDs.

ET impairs liver transplant outcome, likely due to insufficient cooling and/or rewarming of the graft in the donor. Reducing ET or cooling further during hepatectomy might improve outcome.

Fig.1 derived from univariable logistic regression model with random center effect

CITATION INFORMATION: Jochmans I, Fieuws S, Tieken I, Samuel U, Pirenne J. Extraction Time During Liver Retrieval Impairs Survival After Transplantation. Am J Transplant. 2017;17 (suppl 3).

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