title: Macrosteatotic and nonmacrosteatotic grafts respond differently to intermittent hepatic inflow occlusion: Comparison of recipient survival.
abstract: Intermittent hepatic inflow occlusion (IHIO) during liver graft procurement is known to confer protection against graft ischemia/reperfusion injury and thus may benefit the recipient's outcome. We evaluated whether the protective effect of IHIO differs with the presence of macrosteatosis (MaS) and with an increase or decrease in the cumulative occlusion time. The subgroup of 188 recipients who received grafts with MaS was divided into 3 groups according to the number of total IHIO rounds during graft procurement: no IHIO, n = 70; 1 to 2 rounds of IHIO, n = 50; and ≥3 rounds of IHIO, n = 68. Likewise, the subgroup of 200 recipients who received grafts without MaS was divided into 3 groups: no IHIO, n = 108; 1 to 2 rounds of IHIO, n = 40; and ≥3 rounds of IHIO, n = 52. The Cox model was applied to evaluate the association between the number of total IHIO rounds and recipient survival separately in the subgroup of MaS recipients and the subgroup of non-MaS recipients. Analyzed covariables included the etiology, Milan criteria, transfusion, immunosuppression, and others. In the subgroup of MaS recipients, 1 to 2 rounds of IHIO were favorably associated with recipient survival [hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.10-0.80; P = 0.03 after Bonferroni correction], whereas ≥3 rounds of IHIO were not associated with recipient survival (HR, 0.56; 95% CI, 0.25-1.23). In the subgroup of non-MaS recipients, neither 1 to 2 rounds of IHIO (HR, 0.69; 95% CI, 0.30-1.61) nor ≥3 rounds of IHIO (HR, 0.91; 95% CI, 0.42-1.96) were associated with recipient survival. In conclusion, 1 to 2 rounds of IHIO may be used for the procurement of MaS grafts with potential benefit for recipient survival, whereas IHIO has a limited impact on recipient survival regardless of the cumulative occlusion time when it is used for non-MaS grafts.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sangbin
authors.initials: S
authors.lastname: Han
authors.forename: Gyu-Seong
authors.initials: GS
authors.lastname: Choi
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Kwon
authors.forename: Hyo-Won
authors.initials: HW
authors.lastname: Park
authors.forename: Gaabsoo
authors.initials: G
authors.lastname: Kim
authors.forename: Choon Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Gwak
authors.forename: Justin Sangwook
authors.initials: JS
authors.lastname: Ko
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
mesh_terms: D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007511:Ischemia / Q000473:pathology*; D008099:Liver / Q000601:surgery*; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D016016:Proportional Hazards Models; D015427:Reperfusion Injury / Q000517:prevention & control*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome