Consequences of cold-ischemia time on primary nonfunction and patient and graft survival in liver transplantation: a meta-analysis.
BACKGROUND
The ability to preserve organs prior to transplant is essential to the organ allocation process.


OBJECTIVE
The purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant.


METHODS
To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance.


RESULTS
Twenty-six studies met criteria. Functionally, PNF% = -6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean-9.89535)2-0.0067663*(CIT Mean-9.89535)3, r2 = .625, , p<.0001. Mean patient survival: 93% (1 month), 88% (3 months), 83% (6 months) and 83% (12 months). Mean graft survival: 85.9% (1 month), 80.5% (3 months), 78.1% (6 months) and 76.8% (12 months). Maximum patient and graft survival occurred with CITs between 7.5-12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches.


CONCLUSIONS
The results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ.
Stahl
James E
JE
MGH-Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America. Jstahl@partners.org
Kreke
Jennifer E
JE
Malek
Fawaz Ali Abdul
FA
Schaefer
Andrew J
AJ
Vacanti
Joseph
J
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003080:Cold Temperature; D006085:Graft Survival; D006801:Humans; D007511:Ischemia; D016031:Liver Transplantation; D016032:Randomized Controlled Trials as Topic