Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.
Department of Surgery, University of California, San Francisco, CA.
Transplantation. 2018 Nov;102(11):e466-e471. doi: 10.1097/TP.0000000000002380.
In liver transplantation, both cold and warm ischemia times are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known.
We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time, donor risk index, and terminal donor sodium.
Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score (coefficient, 0.021; 95% confidence interval, 0.007-0.035; P < 0.01; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time, and donor risk index had a significant effect on early graft function.
We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation.
在肝移植中，冷缺血时间和热缺血时间都已知会影响早期移植物功能。获取时间是器官冷却初始阶段的一段时间，发生在已故供体获取期间。在此期间，器官有冷却效果不佳的风险。供体提取时间，即从供体主动脉夹闭到将供体器官从体腔中取出的时间，是否会影响早期移植物功能尚不清楚。
我们研究了供体提取时间对 2012 年 6 月至 2016 年 12 月期间在我们中心进行的 292 例本地获取的肝移植受者早期移植物功能的影响。采用早期同种异体功能评分模型评估早期移植物功能，该模型包括供体提取时间、冷缺血时间、热缺血时间、供体风险指数和终末供体钠。
供体提取时间对早期同种异体功能评分模型（系数为 0.021；95%置信区间为 0.007-0.035；P < 0.01；供体提取时间每增加一分钟）测量的早期移植物功能有独立影响。除供体提取时间外，冷缺血时间、热缺血时间和供体风险指数对早期移植物功能也有显著影响。
我们证明了供体提取时间对肝移植后移植物功能的独立影响。努力减少供体提取时间可以改善肝移植的早期移植物功能。
