The impact of combined warm ischemia time on development of acute kidney injury in donation after circulatory death liver transplantation: Stay within the golden hour

AbstractBackgroundAcute kidney injury (AKI) is a common complication after liver transplantation and more frequently observed when high-risk grafts, such as DCD grafts are used. Our aim was to investigate the impact of the ischemia periods on development of AKI in DCD liver transplantation.MethodsWe performed a 2-center retrospective study with 368 DCD graft-recipients. Donor warm ischemia time (DWIT) was divided into agonal phase (withdrawal of life-support – cardiac arrest) and asystolic phase (cardiac arrest – start cold perfusion). We introduced a new period of warm ischemia: the combined warm ischemia time (combined WIT), that was defined as the sum of DWIT and recipient warm ischemia time (RWIT).ResultsAKI was observed in 65% of the recipients and severe AKI in 41% (KDIGO stage 2/3). The length of combined WIT increased significantly with AKI severity: 61 minutes in recipients without AKI up to 69 minutes in recipients with the most severe form of AKI (p

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