Minimising cold ischaemic time is essential in cardiac death donor-associated liver transplantation

Abstract

Background: An important issue in the transplantation of livers procured from cardiac death donors (CDDs) concerns why some centres report equivalent outcomes and others report inferior outcomes in transplantations using CDD organs compared with standard criteria donor (SCD) organs. Resolving this discrepancy may increase the number of usable organs.

Objectives: This study aimed to test whether differences in cold ischaemic time (CIT) are critical during CDD organ transplantation and whether such differences might explain the disparate outcomes.

Methods: Results of CDD liver transplants in our own centre were compared retrospectively with results in a matched cohort of SCD liver recipients. Endpoints of primary non-function (PNF) and ischaemic cholangiopathy (IC) were used because these outcomes are clearly associated with CDD organ use.

Results: In 22 CDD organ transplants, CIT was a strong predictor of PNF or IC (P = 0.021). Minimising CIT in CDD organ transplants produced outcomes similar to those in a matched SCD organ transplant cohort at our centre and in SCD organ transplant results nationally (1- and 3-year graft and patient survival rates: 90.9% and 73.3% vs. 77.6% and 69.2% in CDD and SCD grafts, respectively. A review of the published literature demonstrated that centres with higher CITs tend to have higher rates of PNF or IC (correlation coefficient: 0.41).

Conclusions: These findings suggest that a targeted effort to minimise CIT might improve outcomes and allow the safer use of CDD organs.

© 2011 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Analysis of the literature comparing primary non-function (PNF) and ischaemic cholangiopathy (IC) with cold time when using cardiac death donor livers for transplantation. There is a correlation between the rate of significant complications and increasing cold time (correlation coefficient: 0.41)