Back to Search
Start Over
Revascularization Time in Liver Transplantation: Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation.
- Source :
-
Transplantation [Transplantation] 2018 Dec; Vol. 102 (12), pp. 2038-2055. - Publication Year :
- 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).<br />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).<br />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) resulted in the worst transplant outcome compared with all other groups, which could be mitigated by rapid revascularization (SLG, SLG, MLG vs MLG; 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.<br />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.
- Subjects :
- Acute Kidney Injury etiology
Adult
Databases, Factual
England
Female
Graft Survival
Humans
Liver Transplantation adverse effects
Liver Transplantation mortality
Male
Middle Aged
Primary Graft Dysfunction etiology
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures adverse effects
Vascular Surgical Procedures mortality
Liver Transplantation methods
Operative Time
Vascular Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 102
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 29757901
- Full Text :
- https://doi.org/10.1097/TP.0000000000002263