The Impact of Hepatectomy Time of the Liver Graft on Post-transplant Outcome

Abstract

Donor hepatectomy time impairs liver transplant outcome. Keeping this time short together with efficient cooling during hepatectomy might improve outcome.

Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?

“…The team from King’s College Hospital has suggested a threshold of 40 minutes for DCD retrievals and therefore includes this parameter in their DCD risk score . Additionally, another large study based on the ELTR paralleled such reports, although the median hepatectomy time for DCD procurement was 10 minutes longer here (50 versus 39.5 minutes) compared with our analysis . In their study, Jochmans et al demonstrated a more pronounced impact of hepatectomy time on outcomes after DCD LT when compared with DBD transplants .…”

“…(11) Additionally, another large study based on the ELTR paralleled such reports, although the median hepatectomy time for DCD procurement was 10 minutes longer here (50 versus 39.5 minutes) compared with our analysis. (19) In their study, Jochmans et al demonstrated a more pronounced impact of hepatectomy time on outcomes after DCD LT when compared with DBD transplants. (19) Another study from the Netherlands recently presented a prolonged hepatectomy time of more than 60 minutes as a significant predictor for inferior outcomes in DCD LT. (27) However, the main reason why hepatectomy time did not impact on outcome in our own DCD cohort is probably given by the very homogeneous and shorter hepatectomy time with narrow IQR.…”

“…(19) In their study, Jochmans et al demonstrated a more pronounced impact of hepatectomy time on outcomes after DCD LT when compared with DBD transplants. (19) Another study from the Netherlands recently presented a prolonged hepatectomy time of more than 60 minutes as a significant predictor for inferior outcomes in DCD LT. (27) However, the main reason why hepatectomy time did not impact on outcome in our own DCD cohort is probably given by the very homogeneous and shorter hepatectomy time with narrow IQR. Other timings, including the overall duration of the procedure between WOT and hepatectomy or liver into ice, were assessed here for the first time.…”

“…(17,18) In contrast to recent data from the European Liver Transplant Registry (ELTR), where cold organ flush was performed mainly with HTK, in our United Kingdom cohort, UW solution was used for a majority of the DCD donor procedures. (19) Both solutions were recently shown to be equally protective in the setting of DBD LT with a CIT of up to 15 hours. (20) However, others reported superiority of UW regarding 3-year graft survival in a large ELTR-based European study.…”

Author response to: Comment on: Effect of donor nephrectomy time during circulatory-dead donor kidney retrieval on transplant graft failure

“…Emerging data show a detrimental effect of extraction and implantation time on outcomes after liver and kidney transplantation. Exposure of the organ to lukewarm temperatures for several tens of minutes is presumed to be the causative factor as metabolic rate is linked to temperature.…”