Effects of Cold Ischemia Time on Hepatic Allograft Function

Abstract

-Background:Cold ischemia time is related to success of liver transplantation. Aim: To compare the impact of cold ischemia time on allografts locally collected to those collected distantly. Methods: Were evaluated 83 transplantations. The patients were divided in two groups: those who received liver grafts collected from cities out of Curitiba (n=42) and locally (n=41). From the donors were compared: cause of death, days at ICU, cardiac arrest, vasoactive drugs, lab exams, gender, age, and BMI. Were compared the subsequent information of receptors: cold ischemia time, warm ischemia time, length of surgery, lab exams, etiology of cirrhosis, MELD score, age, gender, histology of graft, use of vasoactive drugs, and blood components transfusion. Were evaluated the correlation between cold ischemia time and lab results. Results: The liver grafts collected from other cities were submitted to a longer cold ischemia time (500±145 min) compared to those locally collected (317,85±105 min). Donors from other cities showed a higher serum sodium level at donation (154±16 mEq/dl) compared to those from Curitiba (144±10 mEq/dl). The length of cold ischemia time was related to serum levels of ALT and total bilirubin. Conclusion: Liver grafts distantly collected underwent longer cold ischemia times, although it caused neither histologic injuries nor higher transfusion demands. There is a correlation between cold ischemia time and hepatic injury, translated by elevation of serum ALT and total bilirubin levels. RESUMO -Racional:O tempo de isquemia fria está relacionado ao sucesso do transplante hepático. Objetivo: Comparar o impacto do tempo dela sobre enxertos captados localmente com os distantes. Métodos: Avaliaram-se 83 transplantes. Os pacientes foram divididos em dois grupos: enxertos captados fora de Curitiba (n=42) e captados localmente (n=41). Dos doadores compararam-se causa do óbito, dias de UTI, parada cardíaca, drogas vasoativas, exames laboratoriais, gênero, idade e IMC. Dos receptores seguintes dados: tempos de isquemia fria e morna, tempo operatório, exames laboratoriais, causa da cirrose, MELD, idade na operação, gênero, biópsia do enxerto, uso de drogas vasoativas e necessidade de transfusões. Foi realizada avaliação de correlação entre o tempo de isquemia fria e os exames laboratoriais. Resultados: Os enxertos captados à distância foram submetidos a maior tempo de isquemia fria (500,3±145 min) quando comparados aos captados localmente (317,85±105 min). Os doadores de fora apresentaram níveis mais elevados de sódio no momento da doação (154±16 mEq/dl) comparados aos doadores de Curitiba (144±10 mEq/dl). Houve correlação entre o tempo de isquemia fria e os níveis de ALT e de bilirrubina total. Não houve diferenças ao comparar-se os demais dados. Conclusão: Enxertos captados à distância sofreram maior tempo de isquemia fria. Isso não refletiu nos prejuízos histológicos nem na demanda transfusional durante o pós-operatório. Houve correlação entre o tempo de isquemia fria e o grau de lesão hepática avaliada p...

Acute Cellular Rejection in Paediatric Liver Transplants: Does a Living Donor Ameliorate the Risk of Rejection in Our Patients? A Retrospective Review at Wits Donald Gordon Medical Centre, South Africa

“…It is further thought that T-memory cells that are generated in an inflammatory environment act as a barrier to tolerance induction. (10) This explanation gives credence to the observation of increasing ACR related to longer CITs (8,(15)(16)(17)(18) and biliary complications,(9) which are known to cause inflammation. Our data illustrates the increased risk of ACR with longer CIT; however, the expected increased risk of ACR was not shown in those patients with biliary complications.…”

“…The mechanism of the inflammatory reaction is likely related to depletion of ATP, increase of free radical and cytokines, progressive cellular dysfunction and apoptosis resulting from progressive ischaemia. (16) CIT is potentially a modifiable factor in LT, and although it is clear that the risk of 3 am surgery may outweigh the risk of a longer CIT, (17) it is noteworthy that we were able to transplant with significantly lower CITs when the donors were living and present at our centre.…”

The use of organ donor blood in liver transplantation

“…However, it is acknowledged that the groups differ with respect to important variables that are likely to impact on graft survival. In particular, in com- [13][14][15][16][17] The lack of significant difference in BPTAR is incongruent with previous animal studies and small clinical studies that found that DST reduces the frequency of acute rejection. [5][6][7][8][9][10] However, this is in keeping with Sato's 18 study which involved a small sample of LT patients receiving postoperative DST through the portal vein.…”

Early graft calcification without graft dysfunction after living donor liver transplantation: two case reports

“…Furthermore, the rates of graft dysfunction were higher in the DDLT cases than in the LDLT cases, possibly due to the longer ischemic time in the DDLT cases. A prolonged cold ischemia time was reported to impair the graft function, increase post-transplantation complications and reduce the survival rate [ 11 , 12 ].…”