Prolonged cold ischemia time as a risk for low regeneration at the early phase after living donor liver transplantation
Takahashi K, Nagai S, Safwan M, Putchakayala K, Rizzari M, Collins K, Yoshida A, Schnickel G, Abouljoud MS. Prolonged cold ischemia time as a risk for low regeneration at the early phase after living donor liver transplantation. Am J Transplant 2017; 17:587.
Am J Transplant
Background. The objective of this study was to determine the risk factors for low liver regeneration at the early phase after living donor liver transplantation (LDLT). Methods. We retrospectively reviewed all ABO-identical adult-to-adult LDLT from December 2007 to March 2015, and enrolled 40 consecutive recipients. Liver regeneration was calculated by the ratio of the liver size on postoperative day (POD) 7 ± 2 days (calculated by computer tomography (CT) volumetry) to the size of the donated liver at the time of transplant. Postoperative outcomes were compared between low and high regenerative groups. The risk factors for low regeneration were analyzed by multivariate analysis, using logistic regression models. Results. Median regeneration rate was 1.67-fold. We classified a regeneration rate of <1.50-fold as the low group and ≥1.5-fold as the high group, using the cutoff value determined by the 25th percentile of the total regeneration rates. Despite no difference in complication rates during admission between the two groups, the rate was significantly higher after discharge to POD 90 in the low regenerative group compared to the high regenerative group (P =0.03) (Table presented). Complication rates also tended to be higher in the low regenerative group after POD 90 (P =0.06). Graft and overall survivals in the low group were significantly worse than those in the high group (P =0.003, P =0.02, respectively). Multivariate analyses showed that cold ischemia time (CIT) (odds ratio =1.44, per 10 min up, P =0.02) was associated with liver regeneration <1.50-fold. Conclusion: Shortening CIT could induce higher liver regeneration after LDLT, leading to a reduction in postoperative complications and improved graft and overall survivals.