Impact of length of donor ICU stay on outcome of patients after pediatric liver transplantation with whole and in situ split liver grafts

Abstract

Background Patients who have a prolonged stay in the intensive care unit (ICU) are often excluded for organ donation because of supposed deleterious effects of a lengthy ICU stay. We aimed to determine the effects of a prolonged donor stay in the ICU on the outcome of liver transplantation (LT) in children. Methods Retrospective review of 89 pediatric LT patients, age 0–18 years, period 2003–2018, including patients having undergone whole organ or in situ split LT. The patients were divided into two groups according to the donor length of stay in the ICU. A prolonged stay was defined as >5 days. Recipient, graft, and donor characteristics were compared; outcome parameters included recipient and graft survival rates and postoperative complications. Results Group short (donor ICU stay <5 days) included 75 patients, group long (donor ICU stay >5 days) 14 patients. Baseline characteristics between recipients did not differ. Donors in group long had significantly more infectious complications and a higher gamma glutamyl transferase (gGT) the day of organ recovery. Incidence of biliary complications post‐LT was significantly higher in group long (p = .029). Patient and graft survival rates did not differ significantly between groups. Conclusions Donors with a prolonged stay in the ICU should still be considered for liver donation if they fulfill most other selection criteria. Recipients from donors having stayed in ICU >5 days may be at increased risk of biliary complications.

Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit

“…Increasing donor LOS was associated with lower hemoglobin levels in our cohort, from the shortest to highest LOS ranging from 11 g/dL over 10 g/dL to 9 g/dL. This goes in line with data from Misar et al in a large pediatric liver transplant cohort [30], as they could observe a decrease in hemoglobin in association with the donor LOS in the ICU. Unfortunately, limited by the information on the donor report, we cannot investigate further explanations; however, it could be speculated that blood transfusion triggers were set at lower levels than usual around the time of brain death.…”

“…Regarding other solid organ transplantations, there is, however, limited and controversial data on adult liver transplant recipients, with some data showing an impact of donor LOS on survival [ 14 , 15 , 16 ], while others do not [ 17 , 18 , 19 ]. Additionally, data from the pediatric liver transplant cohort by Misar et al [ 30 ], although limited by a small sample size of n = 75 in total, suggest no impact on recipient survival, but longer donor LOS in the ICU was associated with increased biliary complication, one of the major complications after liver transplantation. Although biliary complications do not typically arise for heart transplant recipients, this shows that in other solid organ transplantations, a specific major complication was associated with a prolonged LOS in the ICU.…”

Normothermic Machine Perfusion—Improving the Supply of Transplantable Livers for High-Risk Recipients

“…A longer ICU stay does appear to be associated with increased donor infections, however a positive culture in the donor does not appear to influence the recipient’s outcome ( 67 , 68 ). In a study by Misar et al, which compared the outcomes of pediatric recipients who received a graft from a donor following a short (<5 days) or long (≥5 days) ICU stay, there was no difference in overall graft or patient survival ( 67 ). In our practice, we agree with the notion put forward by Strasberg et al in which it is not the length of ICU stay per se that is deleterious, rather the events that transpire during this period ( 69 ).…”

“…A donor ICU length of stay >7 days is considered an extended criteria donor by Eurotransplant, whereas previous consensus meetings have stipulated an ICU length of stay <5 days is ideal for DCD donors ( 59 , 62 ). It seems that a consensus on what comprises a prolonged donor ICU stay is yet to be reached ( 67 ). A longer ICU stay does appear to be associated with increased donor infections, however a positive culture in the donor does not appear to influence the recipient’s outcome ( 67 , 68 ).…”

“…It seems that a consensus on what comprises a prolonged donor ICU stay is yet to be reached ( 67 ). A longer ICU stay does appear to be associated with increased donor infections, however a positive culture in the donor does not appear to influence the recipient’s outcome ( 67 , 68 ). In a study by Misar et al, which compared the outcomes of pediatric recipients who received a graft from a donor following a short (<5 days) or long (≥5 days) ICU stay, there was no difference in overall graft or patient survival ( 67 ).…”