Asystolic donor warm ischemia time is associated with development of postreperfusion syndrome in donation after circulatory death liver transplant

Yuki Bekki, Chiara Rocha, Bryan Myers, Ryan Wang, Natalie Smith, Parissa Tabrizian, Joseph DiNorcia, Jang Moon, Antonios Arvelakis, Marcelo E. Facciuto, Samuel DeMaria, Sander Florman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Individual events during donation after circulatory death (DCD) procurement, such as hypotensive or hypoxic warm ischemia, or circulatory arrest are all a part of donor warm ischemia time (dWIT), and may have differing effects on the outcome of the liver graft. This study aimed to identify risk factors for postreperfusion syndrome (PRS), a state of severe hemodynamic derangement following graft reperfusion, and its impact on DCD liver transplantation (LT) outcomes. Methods: This was a retrospective analysis using 106 DCD LT. Detailed information for events during procurement (withdrawal of life support; systolic blood pressure < 80 mmHg; oxygen saturation < 80%; circulatory arrest; aortic cold perfusion) and their association with the development of PRS were examined using logistic regression. Results: The overall incidence of PRS was 26.4%, occurring in 28 patients. Independent risk factors for PRS were asystolic dWIT (odds ratio (OR) 3.65, 95% confidence interval (CI) 1.38–9.66) and MELD score (OR 1.06, 95% CI 1.01–1.10). Total bilirubin was significantly higher in the PRS group at postoperative day (POD) 1 (p =.02; 5.2 mg/dL vs. 3.4 mg/dL), POD 3 (p =.049; 4.5 mg/dL vs. 2.8 mg/dL), and POD 7 (p =.04; 3.1 mg/dL vs. 1.9 mg/dL). Renal replacement therapy after LT was more likely to be required in the PRS group (p =.01; 48.2% vs. 23.1%). Conclusion: Asystolic dWIT is a risk factor for the development of PRS in DCD LT. Our results suggest that asystolic dWIT should be considered when selecting DCD liver donors.

Original languageEnglish
Article numbere15336
JournalClinical Transplantation
Volume38
Issue number5
DOIs
StatePublished - May 2024

Keywords

  • DCD LT
  • PRS
  • dWIT
  • donor selection

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