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The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients

Adelmann, Dieter, MD, PhD1; Roll, Garrett R., MD2; Kothari, Rishi, MD1; Syed, Shareef, MD2; Burdine, Lyle J., MD, PhD2; Tavakol, Mehdi, MD2; Niemann, Claus U., MD1,2

doi: 10.1097/TP.0000000000002380
Original Clinical Science—Liver

Background In liver transplantation, both cold and warm ischemia times are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known.

Methods We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time, donor risk index, and terminal donor sodium.

Results Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score (coefficient, 0.021; 95% confidence interval, 0.007-0.035; P < 0.01; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time, and donor risk index had a significant effect on early graft function.

Conclusions We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation.

A significant effect of extraction time was observed in a series of DCD recoveries. While this might be confounded by difficulties in the donor cause by obesity or previous surgery it reinforces the view that DCD recovery requires rapid and expert surgical technique.

1 Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.

2 Department of Surgery, University of California, San Francisco, CA.

Received 24 April 2018. Revision received 3 July 2018.

Accepted 10 July 2018.

The authors declare no conflicts of interest.

This study was supported by departmental funds (Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA).

D.A., G.R.R., and C.U.N. drafted the study protocol. C.U.N. obtained Institutional Review Board approval. D.A., M.T. and R.P.K. collected patients' data. D.A. performed the statistical analysis. D.A., G.R.R., S.S., L.J.B, R.P.K., and C.U.N. prepared the article.

Correspondence: Dieter Adelmann, MD, PhD, Department of Anesthesia & Perioperative Care, University of California, San Francisco 521 Parnassus Avenue, San Francisco, CA 94143. (dieter.adelmann@ucsf.edu).

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