Cold ischemia time is an important risk factor for post–liver transplant prolonged length of stay

Abstract

Risk analysis of cold ischemia time (CIT) in liver transplantation has largely focused on patient and graft survival. Posttransplant length of stay is a sensitive marker of morbidity and cost. We hypothesize that CIT is a risk factor for posttransplant prolonged length of stay (PLOS) and aim to conduct an hour-by-hour analysis of CIT and PLOS. We retrospectively reviewed all adult, first-time liver transplants between March 2002 and September 2016 in the United Network for Organ Sharing database. The 67,426 recipients were categorized by hourly CIT increments. Multivariate logistic regression of PLOS (defined as >30 days), CIT groups, and an extensive list of confounding variables was performed. Linear regression between length of stay and CIT as continuous variables was also performed. CIT 1-6 hours was protective against PLOS, whereas CIT >7 hours was associated with increased odds for PLOS. The lowest odds for PLOS were observed with 1-2 hours (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.45-0.92) and 2-3 hours (OR, 0.65; 95% CI, 0.55-0.78) of CIT. OR for PLOS steadily increased with increasing CIT, reaching the greatest odds for PLOS with 13-14 hours (OR, 2.05; 95% CI, 1.57-2.67) and 15-16 hours (OR, 2.06; 95% CI, 1.27-3.33) of CIT. Linear regression revealed a positive correlation between length of stay and CIT with a correlation coefficient of +0.35 (P < 0.001). In conclusion, post-liver transplant length of stay is sensitive to CIT, with a substantial increase in the odds of PLOS observed with nearly every additional hour of cold ischemia. We conclude that CIT should be minimized to protect against the morbidity and cost associated with posttransplant PLOS. Liver Transplantation 24 762-768 2018 AASLD.

Clinical Implications of Donor Warm and Cold Ischemia Time in Donor After Circulatory Death Liver Transplantation

“…We did not find any difference in readmission rates, PNF rates, early mortality, and hyperbilirubinemia between shorter and longer DAT and DWIT. Moreover, DWIT and DAT did not affect the duration of posttransplant hospitalization and readmission rates that are relevant in terms of hospital costs and resource use in health care . A previous large single‐center study (215 patients) evaluated the impact of DWIT and DAT on biliary complications after liver transplant.…”

“…Moreover, DWIT and DAT did not affect the duration of posttransplant hospitalization and readmission rates that are relevant in terms of hospital costs and resource use in health care. (18,19) A previous large single-center study (215 patients) evaluated the impact of DWIT and DAT on biliary complications after liver transplant. In that study, DWIT and DAT did not affect the rates of posttransplant intrahepatic bile duct strictures and overall biliary complications; only the time from asystole to aortic cross-clamp was associated with increased risk for biliary complications.…”

“…Recipient selection is also an important step in liver transplantation, especially in the allocation of marginal organs. (25)(26)(27) The recipients of DCD liver allografts presented a relatively low laboratory MELD score with a median equal to 18 (IQR, [12][13][14][15][16][17][18][19][20][21][22][23][24], whereas in the same period, the median MELD score for braindead donor allograft recipients was 21 (IQR, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Similar findings with lower MELD score in DCD allografts were reported in previous studies.…”

Influence of Preformed Antibodies in Liver Transplantation

“…Cold ischemia time (CIT)is defined as the time in hours from donor liver cross-clamping to cold storage solution removal of the organ [29]. The degree of hepatic fibrosis in all patients included in this study was shown as F4 fibrosis (METAVIR score) at the time of inclusion in the liver transplant waiting list.…”

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

“…First of all, CIT is acknowledged as one of the most important factors affecting reperfusion injury, liver function recovery, and graft survival. (2) However, CIT was significantly different between the microsteatosis and no steatosis groups (P = 0.002), but it was not listed as one of the variables matched for the 2 groups. This may have resulted in bias in evaluating perioperative and postoperative outcomes.…”