In:
Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. 12 ( 2018-12), p. 2038-2055
Abstract:
Strategies for successful transplantation are much needed in the era of organ shortage, and there has been a resurgence of interest on the impact of revascularization time (RT) on outcomes in liver transplantation (LT). Methods All primary LT performed in Birmingham between 2009 and 2014 (n = 678) with portal reperfusion first were stratified according to RT ( 〈 44 minutes vs ≥44 minutes) and graft quality (standard liver graft [SLG], Donor Risk Index 〈 2.3 vs marginal liver graft [MLG], Donor Risk Index ≥ 2.3). Results Revascularization time of 44 minutes or longer resulted in significantly greater incidence of early allograft dysfunction (EAD) (29% vs 47%, P 〈 0.001), posttransplant acute kidney injury (AKI) (39% vs 60%, P 〈 0.001), and new-onset AKI (37% vs 56%, P 〈 0.001), along with poor long-term outcome (3-year graft survival 92% vs 83%, P = 0.001; 3-year patient survival 87% vs 79%, P = 0.004). On multivariable analysis, RT ≥ 44 was a significant independent predictor of EAD, renal dysfunction, and overall graft survival, but not patient survival. The cumulative effect of prolonged revascularization in marginal grafts (MLG RT ≥ 44 ) resulted in the worst transplant outcome compared with all other groups, which could be mitigated by rapid revascularization (SLG RT 〈 44 , SLG RT ≥ 44 , MLG RT 〈 44 vs MLG RT ≥ 44 ; EAD 24%, 39%, 39% vs 69%; AKI 32%, 46%, 51% vs 70%; 3-year graft survival 94%, 87%, 88% vs 70%, respectively; each P 〈 0.001). Factors associated with lack of abdominal space, larger grafts, and surgical skills were predictive of RT ≥ 44. Conclusions Shorter graft revascularization is a protective factor in LT, particularly in the setting of graft marginality. Careful graft-recipient matching and emphasis on surgical expertise may aid in achieving better outcomes in LT.
Type of Medium:
Online Resource
ISSN:
1534-6080
,
0041-1337
DOI:
10.1097/TP.0000000000002263
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
2035395-9
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