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Effect modification in liver allografts with prolonged cold ischemic time.

D L Segev¹, L M Kucirka, G C Nguyen

¹Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. dorry@jhmi.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons

|February 26, 2008

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Prolonged cold ischemia time (PCIT) in liver transplants poses higher graft loss risks for diabetic, obese recipients, and African American donors. These factors significantly amplify PCIT

Area of Science:

Transplantation immunology
Organ transplant outcomes
Surgical risk factors

Background:

Prolonged cold ischemia time (PCIT) is a known risk factor for liver transplant outcomes.
Individual recipient and donor characteristics may influence sensitivity to PCIT.

Purpose of the Study:

To identify specific recipient and donor factors that increase graft loss risk following liver transplantation with PCIT.
To compare the impact of PCIT on graft loss in specific subgroups versus average cold ischemia time (ACIT).

Main Methods:

Analysis of 14,637 liver transplant recipients from the United Network for Organ Sharing (UNOS) database during the Model for End-Stage Liver Disease (MELD) era.
Utilized interaction term analysis within proportional hazards models to assess the impact of PCIT on graft loss.

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Liver Cold Storage and Transplantation in the Cold-Adaptive Daurian Ground Squirrels

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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Published on: August 13, 2014

Examined recipient factors (diabetes, obesity) and donor factors (African American ethnicity).

Main Results:

Recipient diabetes and obesity significantly amplified the adverse effects of PCIT, leading to a 1.85-fold higher risk of graft loss compared to non-diabetic, non-obese recipients with PCIT.
Donor African American ethnicity also amplified PCIT's adverse effects, with an 1.80-fold higher graft loss risk compared to non-African American donors with PCIT.
These risks were notably higher than in non-diabetic, non-obese recipients (1.17-fold) and non-African American donors (1.31-fold) with PCIT.

Conclusions:

Recipient diabetes, obesity, and donor African American ethnicity are critical factors that exacerbate graft loss risk associated with prolonged cold ischemia time in liver transplantation.
Clinical practice should integrate these findings to refine risk assessment and management strategies for liver transplants involving PCIT.
While current practices may mitigate risks from other factors, awareness of these specific high-risk groups is essential for improving transplant outcomes.