Onset of Donor Warm Ischemia Time in Donation After Circulatory Death Liver Transplantation: Hypotension or Hypoxia?

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Marit KalisvaartJeroen de Jonge

Abstract

The aim of this study was to investigate the impact of hypoxia and hypotension during the agonal phase of donor warm ischemia time (DWIT) on hepatic ischemia/reperfusion injury (IRI) and complications in donation after circulatory death (DCD) liver transplantation. A retrospective single-center study of 93 DCD liver transplants (Maastricht type III) was performed. DWIT was divided into 2 periods: the agonal phase (from withdrawal of treatment [WoT] until circulatory arrest) and the asystolic phase (circulatory arrest until cold perfusion). A drop to <80% in peripheral oxygenation (SpO2 ) was considered as hypoxia in the agonal phase (SpO2 -agonal) and a drop to <50 mm Hg as hypotension in the agonal phase (SBP-agonal). Peak postoperative aspartate transaminase level >3000 U/L was considered as severe hepatic IRI. SpO2 dropped within 2 minutes after WoT <80%, whereas the systolic blood pressure dropped to <50 mm Hg after 9 minutes, resulting in a longer SpO2 -agonal (13 minutes) than SBP-agonal (6 minutes). In multiple logistic regression analysis, only duration of SpO2 -agonal was associated with severe hepatic IRI (P = 0.006) and not SBP-agonal (P = 0.32). Also, recipients with long SpO2 -agonal (>13 minutes) had more complica...Continue Reading

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Citations

Jun 8, 2019·Expert Review of Gastroenterology & Hepatology·Marit KalisvaartAndrea Schlegel
Feb 18, 2020·Clinical Transplantation·Ankur Pranjal ChoubeyJorge Ortiz
Apr 29, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Liping Chen, Bingyi Shi
Apr 7, 2020·Minerva anestesiologica·Marinella ZanieratoAlberto Zanella
Apr 21, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Amelia J HessheimerUNKNOWN in representation of the SETH Working Group on DCD
Aug 11, 2020·JAMA Surgery·Marjolein van ReevenWojciech G Polak
May 7, 2021·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Vidya A FleetwoodDavid P Al-Adra
Aug 12, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ola AhmedWilliam C Chapman
Aug 28, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Xavier MullerJean-Yves Mabrut

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