Pharmacologic Donor Management Influences Liver Transplant Graft Survival and Transplant Admission Length of Stay: An Update
1General Surgery
Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
2Division of Transplant Surgery, University of Washington, Seattle, WA
3Division of Transplant Surgery, University of Tennessee Medical Center, Knoxville, TN
4Division of Transplant Surgery, UCSD, San Diego, CA.
Meeting: 2018 American Transplant Congress
Abstract number: D18
Keywords: Donation, Multivariate analysis
Session Information
Session Name: Poster Session D: Donor Management: All Organs Excluding Kidney
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
In liver transplantation, donor management is an area that can be modified to improve survival and lower cost. We reviewed the UNOS Standard Transplant Analysis and Research (STAR) Files for 74,607 liver transplants from 1/1/2003 until 3/31/2016 with 3-month follow-up. The pharmacologic donor management including hormonal, anti-inflammatory, hemodynamic, and other therapies were studied to determine their influence on graft survival and transplant admission length of stay (LOS). Using multivariable Cox proportional hazard analysis and controlling for factors in the DRI, organs procured, region, and cold ischemia; DDAVP (RR-0.92; 95%CI 0.88- 0.96), antihypertensives (RR-0.92; 95%CI 0.88- 0.96), and diuretics (RR-0.91; 95%CI 0.88- 0.94) improved graft survival. T3 decreased graft survival (RR-1.36; 95%CI 1.17–1.57). For LOS, controlling for the same factors, corticosteroids (estimate -0.029d, CI -0.05 to -0.01), antihypertensives (est -0.027d, CI -0.05 to -0.01), and heparin (est -0.084d, CI -0.124 to -0.04) decreased LOS. T3 (est 0.1d, CI 0.08 to 0.19) and vasopressin (est 0.03d, CI 0.01 to 0.05) increased LOS. In summary, the use of DDAVP, antihypertensives, and diuretics in the liver donor improved graft survival; corticosteroids, antihypertensives, and heparin decrease LOS. Further study of pharmacologic donor management will allow us to obtain better recipient outcomes.
| Graft Survival Multivariable Analysis | Risk Ratio | L 95%CI | H 95% CI | P |
| T3 | 1.26 | 1.11 | 1.42 | 0.0003 |
| DDAVP | 0.94 | .091 | 0.98 | 0.0009 |
| Antihypertensives | 0.96 | 0.93 | 0.99 | 0.02 |
| Diuretics | 0.92 | 0.89 | 0.95 | <0.0001 |
| LOS Multivariable Analysis | Estimated days | L 95% CI | U 95% CI | P |
| T3 | 0.1 | 0.008 | 0.19 | 0.04 |
| Vasopressin | 0.03 | 0.01 | 0.05 | 0.004 |
| Steroids | -0.029 | -0.05 | -0.01 | 0.02 |
| Antihypertensives | -0.027 | -0.05 | -0.001 | 0.04 |
| Heparin | -0.084 | -0.124 | -0.04 | <0.0001 |
CITATION INFORMATION: Brandenberger J., Perkins J., Cantafio A., Dick A., Halldorson J., Reyes J. Pharmacologic Donor Management Influences Liver Transplant Graft Survival and Transplant Admission Length of Stay: An Update Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Brandenberger J, Perkins J, Cantafio A, Dick A, Halldorson J, Reyes J. Pharmacologic Donor Management Influences Liver Transplant Graft Survival and Transplant Admission Length of Stay: An Update [abstract]. https://atcmeetingabstracts.com/abstract/pharmacologic-donor-management-influences-liver-transplant-graft-survival-and-transplant-admission-length-of-stay-an-update/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress