Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation.
Donor and recipient factors are closely associated with graft survival after orthotopic liver transplantation (OLT). This study was performed to analyze clinical characteristics of recipients and donors, which affect 30-day graft loss after OLT.


METHODS
One hundred eighty-six livers from heart-beating donors were accepted between May 1997 and June 1998 at the University of Pittsburgh Medical Center. Donor variables that were analyzed included age, sex, cold ischemia time (CIT), warm ischemia time (WIT), imported versus local procurement, cardiopulmonary arrest, serum sodium level, and dopamine dose. The recipient characteristics included native liver disease and UNOS status. Two-sided Fisher exact test and stepwise logistic regression were used for univariate and multivariate analyses. P-values < .05 were considered statistically significant.


RESULTS
Twenty-eight grafts (15.1%) were lost within 30 days of OLT. The following factors were found to adversely affect graft survival: donor sodium > 155 mEq/L (P = .002); CIT > 12 hours (P = .002); WIT > 45 minutes (P = .002); and imported liver graft (P = .048). Logistic regression revealed that donor sodium (odds ratio, 3.03; 95% CI, 1.05 to 8.74), CIT (OR 1.20; 95% CI 1.05 to 1.38), WIT (OR 1.06; 95% CI 1.01 to 1.09) were independent predictors of early graft loss.


CONCLUSIONS
Donor hypernatremia as well as warm and cold ischemia times independently affect graft outcomes in the early postoperative period after OLT. Avoidance of long preservation and correction of donor sodium level are recommended to optimize results and survival in OLT.
Totsuka
E
E
Second Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Japan. etotsuka@cc.hirosaki-u.ac.jp
Fung
U
U
Hakamada
K
K
Tanaka
M
M
Takahashi
K
K
Nakai
M
M
Morohashi
S
S
Nishimura
A
A
Ishizawa
Y
Y
Ono
H
H
Toyoki
Y
Y
Narumi
S
S
Sasaki
M
M
D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome