Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Stahl, James E.; Kreke, Jennifer E.; Malek, Fawaz Ali Abdul; Schaefer, Andrew J.; Vacanti, Joseph Philip

doi:10.1371/journal.pone.0002468

Cited by 97 publications

(82 citation statements)

References 44 publications

(60 reference statements)

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“…The demographic data and clinical parameters of the recipients and donors are shown in Table 2. Multivariate analysis did not find any correlation between degree of IRI and any of the recipient or donor demographics or clinical parameters, including major factors previously implicated in IRI, such as age (13), gender (14), MELD score (15,16), or extended cold ischemia time (17).…”

Section: Olt Recipient and Donor Characteristicsmentioning

confidence: 73%

Early cytokine signatures of ischemia/reperfusion injury in human orthotopic liver transplantation

Sosa¹,

Zarrinpar²,

Rossetti³

et al. 2016

JCI Insight

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IntroductionOrthotopic liver transplant (OLT) is the primary therapy for end-stage liver disease and acute liver failure. Ischemia/reperfusion injury (IRI) occurs as an inevitable consequence of the transplant process, beginning with organ procurement and preservation and followed by reperfusion of the donor organ with recipient blood during transplant (1). Data from murine models have indicated that liver IRI has hypoxic cellular stress and inflammation-mediated injury components (2-5). Local circulatory damage first induces endogenous reactive oxygen species production causing hepatocyte death. This cellular damage initiates the second phase by recruiting and activating innate immune cells at the site of injury. IRI is then further exacerbated by the adaptive immune system; indeed, activated CD4 + T cells are essential in promoting IRI-related inflammation and hepatocyte damage in mice. IRI can lead to primary graft nonfunction and need for retransplantation (6) and predisposes the recipient to both acute and chronic rejection and graft loss as well as decreases the pool of transplantable organs. Although IRI is a signifi-BACKGROUND. Orthotopic liver transplant (OLT) is the primary therapy for end-stage liver disease and acute liver failure. However, ischemia/reperfusion injury (IRI) can severely compromise allograft survival. To understand the evolution of immune responses underlying OLT-IRI, we evaluated longitudinal cytokine expression profiles from adult OLT recipients before transplant through 1 month after transplant.

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Section: Olt Recipient and Donor Characteristicsmentioning

confidence: 73%

Early cytokine signatures of ischemia/reperfusion injury in human orthotopic liver transplantation

Sosa¹,

Zarrinpar²,

Rossetti³

et al. 2016

JCI Insight

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“…For liver transplantation, however, the adverse impact of prolonging cold ischemia is well established, and the window of acceptable CIT is decidedly narrower, to the extent that delaying a recipient operation in favor of a daytime operation could render some grafts unusable (15 Lonze et al …”

Section: The Field Of Transplantation Is Unique Among the Surgical Sumentioning

confidence: 99%

Operative Start Times and Complications After Liver Transplantation

Lonze

Parsikia²,

Feyssa

et al. 2010

American Journal of Transplantation

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The recent national focus on patient safety has led to a re-examination of the risks and benefits of nighttime surgery. In liver transplantation, the hypothetical risks of nighttime operation must be weighed against either the well-established risks of prolonging cold ischemia or the potential risks of strategies to manipulate operative start times. A retrospective review was conducted of 578 liver transplants performed at a single institution between 1995 and 2008 to determine whether the incidence of postoperative complications correlated with operative start times. We hypothesized that no correlation would be observed between complication rates and operative start times. No consistent trends in relative risk of postoperative wound, vascular, biliary, or other complications were observed when eight 3-h time strata were compared. When two 12-h time strata (night, 3 p.m.-3 a.m., and day, 3 a.m.-3 p.m.) were compared, complications were not significantly different, but nighttime operations were longer in duration, and were associated a twofold greater risk of early death compared to daytime operations (adjusted OR 2.9, 95% CI 1.16-7.00, p = 0.023), though long-term survival did not differ significantly between the subgroups. This observation warrants further evaluation and underscores the need to explore and identify institution-specific practices that ensure safe operations regardless of time of day.

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“…2,9,[12][13][14][15][16] Transient liver dysfunction after liver transplant can potentially cause bleeding , thereby increasing the chance of coagulopathic hemorrhage. Our data show that patients who developed coagulopathic-related hemorrhage had significantly lower preoperative platelet counts, a longer cold ischemia time, and greater estimated blood loss than patients with noncoagulopathic-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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Objectives: Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. Materials and Methods:We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Results: Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group. Conclusions: Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant. Key words: Central venous pressure, Cold ischemia time, Computed tomography IntroductionHemorrhage is one of the most common complications after liver transplant, especially during the first postoperative week. 1,2 There are many factors that contribute to postoperative hemorrhage, including the recipient's preoperative condition (for example, coagulopathy, thrombocytopenia), liver graft condition (donors > 60 years, steatosis), surgical technique (inadequate hemostasis of the cut surface of the remnant liver, blood loss from vascular anastomosis, and prolonged cold ischemia time), and recipient's postoperative condition (early graft dysfunction or primary nonfunction, use of heparin, vascular complications). [3][4][5][6] Regardless of the underlying causes of hemorrhage, hemorrhage after liver transplant can be classified as coagulopathic bleeding (bleeding related to poor graft function and coagulopathy, resulting in continuous oozing of blood) or noncoagulopathic bleeding (bleeding in patients with normal coagulation function).Computed tomography (CT) has been reported to be a sensitive modality for detecting active bleeding in patients with major trauma.

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Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Cited by 97 publications

References 44 publications

Early cytokine signatures of ischemia/reperfusion injury in human orthotopic liver transplantation

Early cytokine signatures of ischemia/reperfusion injury in human orthotopic liver transplantation

Operative Start Times and Complications After Liver Transplantation

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