The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients

Background In liver transplantation, both cold- and warm ischemia time are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known. Methods We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time and the donor risk index. Results Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score. (Coefficient 0.018, 95%CI 0.004 to 0.03, P = 0.012; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time and donor risk index had a significant effect on early graft function. Conclusions We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation. Correspondence information: Dieter Adelmann, MD, PhD, Department of Anesthesia & Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA, dieter.adelmann@ucsf.edu Authorship: D.A., G.R.R., and C.U.N. drafted the study protocol. C.U.N. obtained Institutional Review Board approval D.A., M.T. and R.P.K. collected patients' data D.A. performed the statistical analysis D.A., G.R.R., S.S., L.J.B, R.P.K. and C.U.N. prepared the manuscript. Disclosures: The authors declare no conflicts of interest Funding: This study was supported by departmental funds. (Department of Anesthesia and Perioperative Care San Francisco, University of California, San Francisco, CA) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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