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


Journal

Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240

Informations de publication

Date de publication:
May 2024
Historique:
revised: 06 07 2023
received: 08 02 2023
accepted: 03 03 2024
medline: 19 5 2024
pubmed: 19 5 2024
entrez: 19 5 2024
Statut: ppublish

Résumé

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. 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. 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%). 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

pubmed: 38762783
doi: 10.1111/ctr.15336
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e15336

Informations de copyright

© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Références

Siniscalchi A, Gamberini L, Bardi T, et al. Post‐reperfusion syndrome during orthotopic liver transplantation, which definition best predicts postoperative graft failure and recipient mortality? J Crit Care. 2017;41:156‐160.
Bukowicka B, Akar RA, Olszewska A, Smoter P, Krawczyk M. The occurrence of postreperfusion syndrome in orthotopic liver transplantation and its significance in terms of complications and short‐term survival. Ann Transplant. 2011;16(2):26‐30.
Bekki Y, Myers B, Wang R, et al. Postreperfusion syndrome in liver transplantation: outcomes, predictors, and application for recipient selection. Clin Transplant. 2022;36(4):e14587.
Pan X, Apinyachon W, Xia W, et al. Perioperative complications in liver transplantation using donation after cardiac death grafts: a propensity‐matched study. Liver Transpl . 2014;20(7):823‐830.
Taner CB, Bulatao IG, Perry DK, et al. Asystole to cross‐clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int . 2012;25(8):838‐846.
Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant . 2009;9(9):2004‐2011.
Croome KP, Mathur AK, Lee DD, et al. Outcomes of donation after circulatory death liver grafts from donors 50 years or older: a multicenter analysis. Transplantation. 2018;102(7):1108‐1114.
Bekki Y, Kozato A, Kusakabe J, et al. Impact of the donor hepatectomy time on short‐term outcomes in liver transplantation using donation after circulatory death: a review of the US national registry. Clin Transplant. 2022;36(9):e14778.
Firl DJ, Hashimoto K, O'Rourke C, et al. Role of donor hemodynamic trajectory in determining graft survival in liver transplantation from donation after circulatory death donors. Liver Transpl . 2016;22(11):1469‐1481.
Schlegel A, van Reeven M, Croome K, et al. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation. J Hepatol. 2022;76(2):371‐382.
Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc. 1987;19(4):54‐55. Suppl 3.
Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl . 2010;16(8):943‐949.
Kalisvaart M, de Haan JE, Hesselink DA, et al. The postreperfusion syndrome is associated with acute kidney injury following donation after brain death liver transplantation. Transpl Int . 2017;30(7):660‐669.
Hilmi I, Horton CN, Planinsic RM, et al. The impact of postreperfusion syndrome on short‐term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation. Liver Transpl . 2008;14(4):504‐508.
Heylen L, Jochmans I, Samuel U, et al. The duration of asystolic ischemia determines the risk of graft failure after circulatory‐dead donor kidney transplantation: a Eurotransplant cohort study. Am J Transplant . 2018;18(4):881‐889.
Sánchez‐Cámara S, Asensio‐López MC, Royo‐Villanova M, et al. Critical warm ischemia time point for cardiac donation after circulatory death. Am J Transplant 2022;22(5):1321‐1328.
Feizpour CA, Gauntt K, Patel MS, et al. The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death. Am J Transplant 2022;22(5):1451‐1458.
Croome KP, Daneshmand MA. Successfully sharing the sandbox: a perspective on combined DCD liver and heart donor procurement. Am J Transplant 2021;21(2):484‐487.
Bekki Y. Machine perfusion of the heart can increase complexities in the process of donation after circulatory death procurement. Am J Transplant 2022;22(8):2120‐2121.

Auteurs

Yuki Bekki (Y)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Chiara Rocha (C)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Bryan Myers (B)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Ryan Wang (R)

Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Natalie Smith (N)

Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Parissa Tabrizian (P)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Joseph DiNorcia (J)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Jang Moon (J)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Antonios Arvelakis (A)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Marcelo E Facciuto (ME)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Samuel DeMaria (S)

Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Sander Florman (S)

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

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