Risk factors of early allograft dysfunction following C-<b>Ⅱ</b> donation after cardiac death liver transplantation _West China Medical Journal

Authors：

LAN Chuan , ZHANG Ming , YAN Lünan , LI Bo , ZENG Yong , WEN Tianfu ,  XU Mingqing , WANG Wentao , YANG Jiayin

Department of Liver Surgery / Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XU Mingqing, Email: xumingqing0018@163.com

Keywords：

C-Ⅱdonation after cardiac death; Warm ischemic time; Cold ischemic time; Liver transplantation; Early allograft dysfunction

DOI：

10.7507/1002-0179.201603077

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Objective To investigate the risk factors of early allograft dysfunction (EAD) following C-Ⅱ donation after cardiac death (DCD) liver transplantation. Methods The data of 46 donors and recipients of C-ⅡDCD liver transplantation between March 2012 and August 2015 were retrospectively analyzed. The baseline data such as democracy, death cause, donor warm ischemic time (DWIT) and cold ischemic time (CIT) in EAD group and the non-EAD group (control group) was compared, and whether these factors were risk factors of EAD was investigated by univariate and multivariate analyses. Statistical cut-off values for significant factors of the unfavorable analysis were defined by receiver operating characteristics (ROC) analysis. The 6-month and 1-year graft survival rate were compared. Results The EAD group had a longer DWIT compared with the group [(17.6±4.7) and (12.7±6.2) minutes, P=0.009]; meanwhile, the EAD group had a longer CIT compared with the control group [(13.7±4.7) and (11.0±3.5) hours, P=0.020]. The other factors in both groups showed no statistical significance (P>0.05). The ROC curve revealed the cut-off values of DWIT and CIT were 17.50 minutes [area under the curve (AUC)=0.713, P=0.020] and 9.85 hours (AUC=0.723, P=0.015), respectively. The multivariate logistic regression analysis showed the DWIT [odds ratios (OR)=1.340, 95% confidence interval (CI)(1.042, 1.654), P=0.008] and CIT [OR=1.396, 95% CI (1.075, 1.698), P=0.015] were all independent risk factors of EAD. The 6-month and 1-year graft survival rate of the EAD group and the control group was 85.7% vs. 92.3% (P=0.607) and 71.4% vs. 84.6% (P=0.587), respectively. Conclusions EAD may occured in C-Ⅱ donors with DWIT≥17.50 minutes or CIT≥9.85 hours in DCD liver transplantation. The livers can be used as a resource for clinical use and also have a good outcome.

Citation： LAN Chuan, ZHANG Ming, YAN Lünan, LI Bo, ZENG Yong, WEN Tianfu, XU Mingqing, WANG Wentao, YANG Jiayin. Risk factors of early allograft dysfunction following C-Ⅱ donation after cardiac death liver transplantation . West China Medical Journal, 2017, 32(7): 975-979. doi: 10.7507/1002-0179.201603077 Copy

1.	Jay C, Ladner D, Wang E, et al. A comprehensive risk assessment of mortality following donation after cardiac death liver transplant-an analysis of the National registry. J Hepatol, 2011, 55(4): 808-813.
2.	Callaghan CJ, Charman SC, Muiesan P, et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open, 2013, 3(9): e003287.
3.	Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol, 2012, 57(3): 675-688.
4.	Pine JK, Aldouri A, Young AL, et al. Liver transplantation following donation after cardiac death: an analysis using matched pairs. Liver Transpl, 2009, 15(9): 1072-1082.
5.	中华医学会器官移植学会. 中国心脏死亡器官捐献工作指南. 中华器官移植杂志, 2010, 31(7): 436-437.
6.	Schön MR, Kollmar O, Wolf S, et al. Liver transplantation after organ preservation with normothermic extracorporeal perfusion. Ann Surg, 2001, 233(1): 114-123.
7.	Bessems M, Doorschodt BM, Albers PS, et al. Wash-out of the non-heart-beating donor liver: a matter of flush solution and temperature? Liver Int, 2006, 26(7): 880-888.
8.	Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant, 2006, 6(4): 791-796.
9.	Lee KW, Simpkins CE, Montgomery RA, et al. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation, 2006, 82(12): 1683-1688.
10.	Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl, 2010, 16(8): 943-949.
11.	Bernat JL, D’alessandro AM, Port FK, et al. Report of a national conference on donation after cardiac death. Am J Transplant, 2006, 6(2): 281-291.
12.	de Vera ME, Lopez-Solis R, Dvorchik I, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant, 2009, 9(4): 773-781.
13.	Fukumori T, Kato T, Levi D, et al. Use of older controlled non-heart-beating donors for liver transplantation. Transplantation, 2003, 75(8): 1171-1174.
14.	Skaro AI, Jay CL, Baker TB, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery, 2009, 146(4): 543-552; discussion 552-3.
15.	Muiesan P, Girlanda R, Jassem W, et al. Single-center experience with liver transplantation from controlled non-heartbeating donors: a viable source of grafts. Ann Surg, 2005, 242(5): 732-738.
16.	Bellomo R, Marino B, Starkey G, et al. Extended normothermic extracorporeal perfusion of isolated human liver after warm ischaemia: a preliminary report. Crit Care Resusc, 2014, 16(3): 197-201.
17.	Fontes P, Lopez R, Van Der Plaats A, et al. Liver preservation with machine perfusion and a newly developed cell-free Oxygen carrier solution under subnormothermic conditions. Am J Transplant, 2015, 15(2): 381-394.
18.	Bruinsma BG, Avruch JH, Weeder PD, et al. Functional human liver preservation and recovery by means of subnormothermic machine perfusion. J Vis Exp, 2015(98). https://www.ncbi.nlm.nih. gov/pubmed/?term=unctional+human+liver+preservation+and+recovery+by+means+of+subnormothermic+machine+perfusion.
19.	Boehnert MU, Yeung JC, Bazerbachi F, et al. Normothermic acellular ex vivo liver perfusion reduces liver and bile duct injury of pig livers retrieved after cardiac death. Am J Transplant, 2013, 13(6): 1441-1449.

1. Jay C, Ladner D, Wang E, et al. A comprehensive risk assessment of mortality following donation after cardiac death liver transplant-an analysis of the National registry. J Hepatol, 2011, 55(4): 808-813.
2. Callaghan CJ, Charman SC, Muiesan P, et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open, 2013, 3(9): e003287.
3. Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol, 2012, 57(3): 675-688.
4. Pine JK, Aldouri A, Young AL, et al. Liver transplantation following donation after cardiac death: an analysis using matched pairs. Liver Transpl, 2009, 15(9): 1072-1082.
5. 中华医学会器官移植学会. 中国心脏死亡器官捐献工作指南. 中华器官移植杂志, 2010, 31(7): 436-437.
6. Schön MR, Kollmar O, Wolf S, et al. Liver transplantation after organ preservation with normothermic extracorporeal perfusion. Ann Surg, 2001, 233(1): 114-123.
7. Bessems M, Doorschodt BM, Albers PS, et al. Wash-out of the non-heart-beating donor liver: a matter of flush solution and temperature? Liver Int, 2006, 26(7): 880-888.
8. Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant, 2006, 6(4): 791-796.
9. Lee KW, Simpkins CE, Montgomery RA, et al. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation, 2006, 82(12): 1683-1688.
10. Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl, 2010, 16(8): 943-949.
11. Bernat JL, D’alessandro AM, Port FK, et al. Report of a national conference on donation after cardiac death. Am J Transplant, 2006, 6(2): 281-291.
12. de Vera ME, Lopez-Solis R, Dvorchik I, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant, 2009, 9(4): 773-781.
13. Fukumori T, Kato T, Levi D, et al. Use of older controlled non-heart-beating donors for liver transplantation. Transplantation, 2003, 75(8): 1171-1174.
14. Skaro AI, Jay CL, Baker TB, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery, 2009, 146(4): 543-552; discussion 552-3.
15. Muiesan P, Girlanda R, Jassem W, et al. Single-center experience with liver transplantation from controlled non-heartbeating donors: a viable source of grafts. Ann Surg, 2005, 242(5): 732-738.
16. Bellomo R, Marino B, Starkey G, et al. Extended normothermic extracorporeal perfusion of isolated human liver after warm ischaemia: a preliminary report. Crit Care Resusc, 2014, 16(3): 197-201.
17. Fontes P, Lopez R, Van Der Plaats A, et al. Liver preservation with machine perfusion and a newly developed cell-free Oxygen carrier solution under subnormothermic conditions. Am J Transplant, 2015, 15(2): 381-394.
18. Bruinsma BG, Avruch JH, Weeder PD, et al. Functional human liver preservation and recovery by means of subnormothermic machine perfusion. J Vis Exp, 2015(98). https://www.ncbi.nlm.nih. gov/pubmed/?term=unctional+human+liver+preservation+and+recovery+by+means+of+subnormothermic+machine+perfusion.
19. Boehnert MU, Yeung JC, Bazerbachi F, et al. Normothermic acellular ex vivo liver perfusion reduces liver and bile duct injury of pig livers retrieved after cardiac death. Am J Transplant, 2013, 13(6): 1441-1449.

West China Medical Journal

Risk factors of early allograft dysfunction following C-Ⅱ donation after cardiac death liver transplantation

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