Impact of Cold Ischemia Time on the Function of Liver Grafts Preserved With Custodiol

Rodrigues, Marina Guitton; Castro, Paula Marcela Vilela; Almeida, Tiago Careli de; Danziere, Fernanda Ribeiro; Filho, Francisco Antonio Sergi; Sempertegui, Beimar Edmundo Zeballos; Branez, Juan Rafel; Mota, Leonardo; Miranda, Marcelo Perosa de; Santos, Randolfo dos; Genzini, Tércio

doi:10.1016/j.transproceed.2020.03.002

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…In particular, prolonged warm ischemia time is believed to be related to various complications; therefore, longterm outcomes need to be analyzed (16). Bench-surgery time is an important factor impacting graft quality, as it is related to cold ischemia time (17)(18)(19). The graft quality, such as if additional trimming or bench-surgery procedures are required, can affect bench-surgery time.…”

Section: Discussionmentioning

confidence: 99%

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time

Hong

Han

et al. 2021

Front. Surg.

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Background: Recently, there have been several reports on pure laparoscopic donor right hepatectomy (PLDRH), but the effect of pure laparoscopy on bench surgery has not been evaluated. This study aimed to compare bench-surgery time between PLDRH and conventional donor right hepatectomy (CDRH).Methods: We retrospectively reviewed the medical records of 758 live liver donors between January 2012 and December 2019. We divided the patients into two groups: between January 2012 and September 2015, when we exclusively performed CDRH, and between March 2016 and December 2019, when PLDRH was standardized. We excluded all other types of graft donor hepatectomy, laparoscopic assisted donor hepatectomy, and cases with no recorded data.Results: In total, 267 donors were included in the PLDRH group and were compared with 247 donors in the CDRH group. Similar proportions of graft vascular variations were observed between the two groups. The mean bench-surgery time was longer in the PLDRH group than in the CDRH group (49.3 ± 19.9 vs. 39.5 ± 17.5 min; P < 0.001).Conclusion: The bench-surgery time was longer in the PLDRH group than the CDRH group, regardless of whether the vascular network was reconstructed. Expertise in bench-surgery as well as donor surgery and recipient surgery is mandatory for PLDRH to be safe and feasible.

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Section: Discussionmentioning

confidence: 99%

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time

Hong

Han

et al. 2021

Front. Surg.

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“…How far cold ischemic time can be acceptable to the high-risk liver transplant candidate is a still open question. In liver transplantation using HTK solution, cold ischemic time more than 8 hours generated poor clinical outcome [14]. In this study longest graft ischemic time was 388 minutes in left liver graft on the third deceased donor.…”

Section: Discussionmentioning

confidence: 56%

Experience of split liver transplantation from deceased marginal donor: eight adult recipients from four deceased donors

You

Chun

Choi

et al. 2022

Ann Liver Transplant

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Background: Split liver transplantation has been explored as one of method to increase donor supply. Concerns about the complexity and increased risk of vascular and biliary complexity makes split liver transplantation stable so far. Technical complexity has been overcome in South Korea due to abundant experience of living donor liver transplantation. However, liver transplantation of full right and full left liver has not been popularized because of ambiguousness in allocation policy for adult split liver in Korea. Methods: Four deceased marginal donor split liver procedures were performed for eight adult recipients in our institute since 2017. Results: Three of four donors had elevated aspartate aminotransferase or alanine aminotransferase level beyond three times of reference range. One of them was 60 years old. Three splits were made in situ and one split procedure was carried out ex vivo. After splitting liver, all four right graft were allocated to patients of high model for end-stage liver disease score and the left grafts with main vascular structures were transplanted to sub-urgent waiting list individuals. Graft to recipient body weight ratio range for both right and left liver graft were 1.5 to 2.2 and 0.9 to 1.4 respectively. Cold ischemic time ranged from 59 minutes to 388 minutes. Graft liver function of all recipients recovered without remarkable events. One recipient of right liver graft died in 11 post-transplantation months due to aggravating preexisting myelofibrosis and one left liver recipient for liver re-transplantation of primary liver graft failure expired due to cerebral infarct on post-transplantation 21 days. Conclusion: Split liver graft from selected deceased marginal donor graft to both adult recipients has the potential to expand donor pool.

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“…Compared to Golse et al., we excluded recipients of living‐donor liver transplants, split grafts, domino transplants, and combined procedures other than SLKT. This allowed us to minimize confounding factors that can affect lactate clearance, such as graft size and differences in cold and warm ischemia times 23,24 . Finally, the predictive value of a variable depends on its distribution in the underlying cohort.…”

Section: Discussionmentioning

confidence: 99%

“…This allowed us to minimize confounding factors that can affect lactate clearance, such as graft size and differences in cold and warm ischemia times. 23,24 Finally, the predictive value of a variable depends on its distribution in the underlying cohort. We explored the lactate concentration at the end of transplant distribution in our population, but we did not have data to compare with the study of Golse The present study has some limitations.…”

Section: Graft Typementioning

confidence: 99%

Lactate concentration at the end of liver transplant: Early predictor of graft function or just one piece of the puzzle?

Galli

Kothari

Adelmann

et al. 2023

Clinical Transplantation

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BackgroundThe post‐operative course after Liver Transplantation (LT) can be complicated by early allograft dysfunction (EAD), primary nonfunction (PNF) and death. A lactate concentration at the end of transplant of ≥5 mmol/L was recently proposed as a predictive marker of PNF, EAD, and mortality; this study aimed to validate these previous reports in a large single center cohort.MethodsThis retrospective cohort study included adult liver transplant recipients who received grafts from deceased donors at our center between June 2012 and May 2021. Receiver operating characteristic (ROC) curves for the lactate concentration at the end of transplantation were computed to determine the AUC for PNF, EAD and mortality at 90 days.ResultsIn our cohort of 1137 cases, the AUCs for lactate to predict EAD, PNF and mortality were respectively .56 (95% confidence interval [CI]: .53–.60), .69 (95% CI: .52–.85), and .74 (95% CI: .63–.84).ConclusionThe clinical value of lactate concentration at the end of transplantation to predict PNF, EAD and mortality at 90 days was, at best, modest, as shown by the relatively low AUCs. Our findings cannot validate previous reports that the lactate level alone is a good predictor of poor outcomes after liver transplantation.

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Impact of Cold Ischemia Time on the Function of Liver Grafts Preserved With Custodiol

Cited by 5 publications

References 16 publications

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time

Experience of split liver transplantation from deceased marginal donor: eight adult recipients from four deceased donors

Lactate concentration at the end of liver transplant: Early predictor of graft function or just one piece of the puzzle?

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