Cold Ischemia Time as a Factor in Post-transplantation Complications for Orthotopic Hepatic Transplantation

This study aims to compare a shorter cold ischemia time with the present one in relation to the complications developed in liver transplantations.

This is a retrospective, observational study of orthotopic liver transplantations performed with grafts from brain-dead donors during 12 months at a University Hospital (Seville). We compare incidence rates of complications (reperfusion syndrome, arterial and biliary complications, and prostaglandin requirements) between two groups according to cold ischemia times (group A < 6 hours; group B > 6 hours).

Sixty cases were included. There were more males in both groups as donors (55.5%) and recipients (75%). The median age was higher in group B in two cases. The Model for End-stage Liver Disease score was higher in patients with a shorter cold ischemia time, with a median of 20 hours (range, 16 to 26.5 hours). We observed that reperfusion syndrome (3.4% vs. 13.3%; P = .353), vascular complications (6.9% vs. 24.1%; P = .144), biliary tract complications (13.8% vs. 20.7%; P = .730), and prostaglandin requirements (3.4% vs. 20.7%; P = .102) were more common in group B, although without reaching statistical significance. After uni- and multivariate analyses, cold ischemia time longer than 6 hours was the only risk factor to develop complications (odds ratio: 3.578; 95% confidence interval: 1.125 to 11.374, P = .031).

According to the results of our analysis, cold ischemia times longer than 6 hours, as tends to be the usual procedure in most centers, imply higher rates of complications after liver transplantation.