Nicholas Gilbo1,2, Steffen Fieuws3, Nicolas Meurisse4, Frederik Nevens5, Schalk van der Merwe5, Wim Laleman5, Chris Verslype5, David Cassiman5, Hannah van Malenstein5, Tania Roskams6, Mauricio Sainz-Barriga1,2, Jacques Pirenne1,2, Ina Jochmans1,2, Diethard Monbaliu1,2. 1. Lab of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium. 2. Abdominal Transplantation Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium. 3. Department of Public Health, Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium. 4. Department of Abdominal Transplant Surgery, University of Liege Academic Hospital, Liège, Belgium. 5. Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium. 6. Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium.
Abstract
BACKGROUND: Donor hepatectomy and liver implantation time reduce long-term graft and patient survival after liver transplantation. It is not known whether these surgical times influence early outcomes after liver transplantation. METHODS: This single-center study evaluated the effect of donor hepatectomy and implantation time on the risk of nonanastomotic biliary strictures (NAS) occurring within 1 year and of early allograft dysfunction (EAD) after deceased-donor solitary liver transplantation, adjusting for other donors, recipient, and surgical factors. RESULTS: Of 917 transplants performed between January 2000 and December 2016, 106 (11.56%) developed NAS and 247 (27%) developed EAD. Donor hepatectomy time (median 35 min, IQR: 26-46) was an independent risk factor of NAS [adjusted hazard ratio, 1.19; 95% CI, 1.04-1.35; P = 0.01]. Implantation time (median 80 min, IQR: 69-95) was independently associated with EAD [adjusted odds ratio (OR), 1.15; 95% CI,1.07-1.23; P < 0.0001). The risk of EAD was increased by anastomosis time of both portal vein (adjusted OR, 1.26; 95% CI, 1.12-14.42; P = 0.0001) and hepatic artery (adjusted OR, 1.13; 95% CI, 1.04-1.22; P = 0.005). The magnitude of these effects was similar in donation after circulatory death liver grafts. CONCLUSIONS: Donor hepatectomy and implantation time negatively affect short-term outcomes.
BACKGROUND: Donor hepatectomy and liver implantation time reduce long-term graft and patient survival after liver transplantation. It is not known whether these surgical times influence early outcomes after liver transplantation. METHODS: This single-center study evaluated the effect of donor hepatectomy and implantation time on the risk of nonanastomotic biliary strictures (NAS) occurring within 1 year and of early allograft dysfunction (EAD) after deceased-donor solitary liver transplantation, adjusting for other donors, recipient, and surgical factors. RESULTS: Of 917 transplants performed between January 2000 and December 2016, 106 (11.56%) developed NAS and 247 (27%) developed EAD. Donor hepatectomy time (median 35 min, IQR: 26-46) was an independent risk factor of NAS [adjusted hazard ratio, 1.19; 95% CI, 1.04-1.35; P = 0.01]. Implantation time (median 80 min, IQR: 69-95) was independently associated with EAD [adjusted odds ratio (OR), 1.15; 95% CI,1.07-1.23; P < 0.0001). The risk of EAD was increased by anastomosis time of both portal vein (adjusted OR, 1.26; 95% CI, 1.12-14.42; P = 0.0001) and hepatic artery (adjusted OR, 1.13; 95% CI, 1.04-1.22; P = 0.005). The magnitude of these effects was similar in donation after circulatory death liver grafts. CONCLUSIONS: Donor hepatectomy and implantation time negatively affect short-term outcomes.
Authors: Naeem Goussous; Josue Alvarez-Casas; Noor Dawany; Wen Xie; Saad Malik; Stephen H Gray; Rolf N Barth; John C LaMattina Journal: Transplant Direct Date: 2021-12-23
Authors: Raphael P H Meier; Yvonne Kelly; Seiji Yamaguchi; Hillary J Braun; Tyler Lunow-Luke; Dieter Adelmann; Claus Niemann; Daniel G Maluf; Zachary C Dietch; Peter G Stock; Sang-Mo Kang; Sandy Feng; Andrew M Posselt; James M Gardner; Shareef M Syed; Ryutaro Hirose; Chris E Freise; Nancy L Ascher; John P Roberts; Garrett R Roll Journal: Front Surg Date: 2022-01-05