Synergistic effect of cold and warm ischemia time on postoperative graft outcome in human liver transplantation.
OBJECTIVE
Prolonged cold ischemia time (CIT) during graft preservation and warm ischemia time (WIT) defined as a rewarming time have been reported to cause postoperative graft dysfunction after orthotopic liver transplantation (OLT). However, a synergistic effect of both CIT and WIT on patients of graft survival has not been confirmed. The aim of this study was to determine whether simultaneously prolonged CIT and WIT was associated with early graft outcome after clinical OLT.


METHODS
Between May 1997 and July 1998, 186 consecutive OLT cases were divided into 4 groups as follows: group A, CIT < or =12 hrs and WIT < or =45 min; group B, CIT >12 hrs and WIT < or =45 min; group C, CIT < or =12 hrs and WIT >45 min; and group D, CIT > 12 hrs and WIT >45 min. Liver graft survival within 90 days of OLT and early postoperative graft function were analyzed.


RESULTS
The graft loss rates were 5.4% in group A, 9.8% in group B, 11.1% in group C, and 42.9% in group D. The mean highest aspartate aminotransferase (AST) values after OLT in group D (3352.3+/-569.4 U/L) was significantly higher than those in groups A (1411.7+/-169.2 U/L) and B (1931.3+/-362.6 U/L).


CONCLUSIONS
The simultaneously prolonged cold and warm ischemia time significantly caused hepatic allograft injury and failure, suggesting some synergistic effects of CIT and WIT on postoperative graft function.
Totsukali
Eishi
E
Second Department of Surgery, Hirosaki University School of Medicine, Hirosaki Japan. etotsuka@cc.hirosaki-u.ac.jp
Fung
John J
JJ
Ishizawa
Yoshiya
Y
Nishimura
Akimasa
A
Ono
Hiroaki
H
Toyoki
Yoshikazu
Y
Narumi
Shuniji
S
Hakamada
Kenichi
K
Sasaki
Mutsuo
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D017093:Liver Failure / Q000401:mortality / Q000503:physiopathology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage; D013696:Temperature; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone