In the era of marginal organ utilization, the impact of revascularization time (RT) on outcomes in liver transplantation (LT) has not been reported.
All primary LT performed in Birmingham between 2009 and 2014 (n=678) with portal reperfusion first were stratified according to RT (<44 vs. ≥44 min) and graft quality (SLG, Donor risk index [DRI]<2.3 vs. MLG, DRI≥2.3).
Compared to RT<44, a significantly greater incidence of early allograft dysfunction (EAD) (29% vs. 47%, p=<0.001), post-transplant acute kidney injury (AKI) (39% vs. 60%, p=<0.001) and new-onset AKI after LT (37% vs. 56%, p=<0.001) occurred after RT≥44. RT≥44 was also associated with adverse long-term outcome (3-year graft survival 92% vs. 83%, p=0.001; 3-year patient survival 87% vs. 79%, p=0.004). RT≥44 independently predicted EAD, renal dysfunction and overall graft but not patient survival. The cumulative effect of prolonged revascularization in marginal grafts (MLGRT≥44) resulted in the worst transplant outcome compared to all other groups which could be mitigated by rapid revascularization (SLGRT<44, SLGRT≥44, MLGRT<44 vs. MLGRT≥44, EAD 24%, 39%, 39% vs. 69%, respectively; p=<0.001 and 3-year graft survival 94%, 87%, 88% vs. 70%, respectively; p=<0.001)(Figure 1).
Prolonged graft revascularization places outcomes particularly of marginal liver grafts at risk, and this is a modifiable variable that relies on the expertise of the implanting surgeon and also has implications for transplant surgical training.