Background: 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 (MLGRT ≥ 44) resulted in the worst transplant outcome compared with all other groups, which could be mitigated by rapid revascularization (SLGRT < 44, SLGRT ≥ 44, MLGRT < 44 vs MLGRT ≥ 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.

Revascularization Time in Liver Transplantation : Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation / B.M. Buchholz, U.A. Gerlach, V.V. Chandrabalan, J. Hodson, B.K. Gunson, H. Mergental, P. Muiesan, J.R. Isaac, K.J. Roberts, D.F. Mirza, M.T.P.R. Perera. - In: TRANSPLANTATION. - ISSN 0041-1337. - 102:12(2018), pp. 2038-2055. [10.1097/TP.0000000000002263]

Revascularization Time in Liver Transplantation : Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation

P. Muiesan;
2018

Abstract

Background: 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 (MLGRT ≥ 44) resulted in the worst transplant outcome compared with all other groups, which could be mitigated by rapid revascularization (SLGRT < 44, SLGRT ≥ 44, MLGRT < 44 vs MLGRT ≥ 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.
Acute Kidney Injury; Adult; Databases, Factual; England; Female; Graft Survival; Humans; Liver Transplantation; Male; Middle Aged; Primary Graft Dysfunction; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Operative Time
Settore MED/18 - Chirurgia Generale
2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/884050
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