title: Minimising cold ischaemic time is essential in cardiac death donor-associated liver transplantation.
abstract: BACKGROUND
  An important issue in the transplantation of livers procured from cardiac death donors (CDDs) concerns why some centres report equivalent outcomes and others report inferior outcomes in transplantations using CDD organs compared with standard criteria donor (SCD) organs. Resolving this discrepancy may increase the number of usable organs.
  
  
  OBJECTIVE
  This study aimed to test whether differences in cold ischaemic time (CIT) are critical during CDD organ transplantation and whether such differences might explain the disparate outcomes.
  
  
  METHODS
  Results of CDD liver transplants in our own centre were compared retrospectively with results in a matched cohort of SCD liver recipients. Endpoints of primary non-function (PNF) and ischaemic cholangiopathy (IC) were used because these outcomes are clearly associated with CDD organ use.
  
  
  RESULTS
  In 22 CDD organ transplants, CIT was a strong predictor of PNF or IC (P = 0.021). Minimising CIT in CDD organ transplants produced outcomes similar to those in a matched SCD organ transplant cohort at our centre and in SCD organ transplant results nationally (1- and 3-year graft and patient survival rates: 90.9% and 73.3% vs. 77.6% and 69.2% in CDD and SCD grafts, respectively. A review of the published literature demonstrated that centres with higher CITs tend to have higher rates of PNF or IC (correlation coefficient: 0.41).
  
  
  CONCLUSIONS
  These findings suggest that a targeted effort to minimise CIT might improve outcomes and allow the safer use of CDD organs.
authors: Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. skarp@bidmc.harvard.edu
authors: Seth J
authors: SJ
authors: Karp
authors: Scott
authors: S
authors: Johnson
authors: Amy
authors: A
authors: Evenson
authors: Michael P
authors: MP
authors: Curry
authors: Diarmuid
authors: D
authors: Manning
authors: Raza
authors: R
authors: Malik
authors: Gerond
authors: G
authors: Lake-Bakaar
authors: Michelle
authors: M
authors: Lai
authors: Douglas
authors: D
authors: Hanto
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