title: Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time.
abstract: BACKGROUND
  Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF).
  
  
  METHODS
  A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF.
  
  
  RESULTS
  From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases.
  
  
  CONCLUSIONS
  Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Somak
authors.initials: S
authors.lastname: Das
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Sudeepta Kumar
authors.initials: SK
authors.lastname: Swain
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Pavan Kumar
authors.initials: PK
authors.lastname: Addala
authors.affiliation: 2 Biostatistics, Apollo Hospital, Chennai, India.
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Balasubramaniam
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: C V
authors.initials: CV
authors.lastname: Gopakumar
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Zirpe
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Kirubakaran
authors.initials: K
authors.lastname: Renganathan
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Kollu
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Darshan
authors.initials: D
authors.lastname: Patel
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Bipin B
authors.initials: BB
authors.lastname: Vibhute
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Prashantha S
authors.initials: PS
authors.lastname: Rao
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Elankumaran
authors.initials: E
authors.lastname: Krishnan
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gopasetty
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Anand K
authors.initials: AK
authors.lastname: Khakhar
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.|3 Oxford Division of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Ramamurthy
mesh_terms: D050377:Cold Ischemia; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: acidosis; deceased-donor liver transplantation; extended criteria liver graft; initial poor function; macrosteatosis; marginal liver graft; primary nonfunction