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Impact of Donor Hepatectomy Time During Organ Procurement in Donation After Circulatory Death Liver Transplantation

The United Kingdom Experience

Farid, Shahid G., FRCS1; Attia, Magdy S., FRCS1; Vijayanand, Dhakshina, FRCS1; Upasani, Vivek, MRCS1; Barlow, Adam D., FRCS1; Willis, Sean, PhD1; Hidalgo, Ernest, FRCS1; Ahmad, Niaz, FRCS1

doi: 10.1097/TP.0000000000002518
Original Clinical Science—Liver
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Background. No data exist to evaluate how hepatectomy time (HT), in the context of donation after cardiac death (DCD) procurement, impacts short- and long-term outcomes after liver transplantation (LT). In this study, we analyze the impact of the time from aortic perfusion to end of hepatectomy on outcomes after DCD LT in the United Kingdom.

Methods. An analysis of 1112 DCD donor LT across all UK transplant centers between 2001 and 2015 was performed, using data from the UK Transplant Registry. Donors were all Maastricht Category III. Graft survival after transplantation was estimated using Kaplan-Meier method and logistic regression to identify risk factors for primary nonfunction (PNF) and short- and long-term graft survivals after LT.

Results. Incidence of PNF was 4% (40) and in multivariate analysis only cold ischemia time (CIT) longer than 8 hours (hazard ratio [HR], 2.186; 95% confidence interval [CI], 1.113–4.294; P = 0.023) and HT > 60 minutes (HR, 3.669; 95% CI, 1.363–9.873; P = 0.01) were correlated with PNF. Overall 90-day, 1-, 3-, and 5-year graft survivals in DCD LT were 91.2%, 86.5%, 80.9%, and 77.7% (compared with a donation after brain death cohort in the same period [n = 7221] 94%, 91%, 86.6%, and 82.6%, respectively [P < 0.001]). In multivariate analysis, the factors associated with graft survival were HT longer than 60 minutes, donor older than 45 years, CIT longer than 8 hours, and recipient previous abdominal surgery.

Conclusions. There is a negative impact of prolonged HT on outcomes on DCD LT and although HT is 60 minutes or longer is not a contraindication for utilization, it should be part of a multifactorial assessment with established prognostic donor factors, such as age (>45 y) and CIT (>8 h) for an appropriately selected recipient.

1 Department of HPB and Transplantation, St James University Hospital, Beckett Street, Leeds, United Kingdom.

Received 14 April 2018. Revision received 22 October 2018.

Accepted 29 October 2018.

The authors declare no conflicts of interest.

S.G.F. participated in research design, performance of the research, statistical analysis, writing, and final review of the article. M.S.A. participated in research design and final review of the article. D.V. participated in research design, writing, and final review of the article. V.U. participated in research design, performance of the research, statistical analysis, writing, and final review of the article. S.W. participated in research design, performance of the research, statistical analysis, writing, and final review of the article. A.B. participated in the writing and final review of the article. E.H. participated in research design, performance of the research, writing, and final review of the article. N.A. participated in research design, performance of the research, statistical analysis, writing, and final review of the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Shahid Farid, FRCS, Department of Transplantation, St James University Hospital, Beckett St, Leeds, LS9 7TF, United Kingdom. (s.farid@nhs.net).

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