Preharvest donor hyperoxia predicts good early graft function and longer graft survival after liver transplantation.
A total of 44 donor/recipient perioperative and intraoperative variables were prospectively analyzed in 89 deceased-donor liver transplantations classified as initial good graft function (IGGF) or initial poor graft function (IPGF) according to a scoring system based on values obtained during the 1st 72 postoperative hours from the serum alanine aminotransferase (ALT) concentration, bile output, and prothrombin activity. The IGGF compared with the IPGF group showed: 1) longer graft (P = .002) and patient (P = .0004) survival; 2) at univariate analysis, a higher (mean [95% confidence interval]) preharvest donor arterial partial pressure of oxygen (PaO(2)) (152 [136-168] and 104 [91-118] mmHg, respectively; P = .0008) and arterial hemoglobin oxygen saturation (97.9 [97.2-98.7] and 96.7 [95.4-98.0]%, respectively; P = .0096), a lower percentage of donors older than 65 years (13 and 33%, respectively; P = .024), a lower percentage of donors treated with noradrenaline (16 and 41%, respectively; P = .012). At multivariate analysis, IGGF was associated positively with donor PaO(2) and negatively with donor age greater than 65 years and with donor treatment with noradrenaline. Independently from the grouping according to initial graft function, graft survival was longer when donor PaO(2) was >150 mmHg than when donor PaO(2) was < or =150 mmHg (P = .045). In conclusion, preharvest donor hyperoxia predicts IGGF and longer graft survival.
Corradini
Stefano Ginanni
SG
Division of Gastroenterology, Department of Clinical Medicine, University La Sapienza, Rome, Italy. stefano.corradini@uniroma1.it
Elisei
Walter
W
De Marco
Rosanna
R
Siciliano
Maria
M
Iappelli
Massimo
M
Pugliese
Francesco
F
Ruberto
Franco
F
Nudo
Francesco
F
Pretagostini
Renzo
R
Bussotti
Alessandro
A
Mennini
Gianluca
G
Eramo
Annarita
A
Liguori
Francesca
F
Merli
Manuela
M
Attili
Adolfo Francesco
AF
Muda
Andrea Onetti
AO
Natalizi
Stefania
S
Berloco
Pasquale
P
Rossi
Massimo
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001784:Blood Gas Analysis; D002648:Child; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting
D000410:Alanine Transaminase; D010100:Oxygen