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 language | English |
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Article number | e15336 |
Journal | Clinical Transplantation |
Volume | 38 |
Issue number | 5 |
DOIs | |
State | Published - May 2024 |
Keywords
- DCD LT
- PRS
- dWIT
- donor selection