title: Effect of airplane transport of donor livers on post-liver transplantation survival.
abstract: OBJECTIVE
  To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes.
  
  
  METHODS
  A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression.
  
  
  RESULTS
  One hundred and ninety-three patients received a local donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase (mean: 45 U/Lvs84 U/L,P= 0.035), higher donor risk index (mean: 1.88vs1.42,P< 0.001) and longer cold ischemic time (CIT) (mean: 10.1 hvs6.4 h,P< 0.001). There was a weak correlation between CIT and transport distance (r2= 0.29,P< 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss (HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver (P= 0.027).
  
  
  CONCLUSIONS
  Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Gerry
authors.initials: G
authors.lastname: MacQuillan
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Collins
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Albert
authors.initials: A
authors.lastname: Nwaba
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Linjun
authors.initials: L
authors.lastname: Mou
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Max K
authors.initials: MK
authors.lastname: Bulsara
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Luc
authors.initials: L
authors.lastname: Delriviere
authors.affiliation: Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jeffrey
mesh_terms: D000328:Adult; D000401:Aircraft; D016009:Chi-Square Distribution; D050377:Cold Ischemia; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014904:Western Australia
keywords: Airplane transportation; Cold ischemic time; Donor location; Graft survival; Organ damage