دورية أكاديمية
Revascularization Time in Liver Transplantation: Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation
| العنوان: | Revascularization Time in Liver Transplantation: Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation |
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| المؤلفون: | Buchholz, Bettina M., Gerlach, Undine A., Chandrabalan, Vishnu V., Hodson, James, Gunson, Bridget K., Mergental, Hynek, Muiesan, Paolo, Isaac, John R., Roberts, Keith J., Mirza, Darius F., Perera, M. Thamara P. R. |
| المصدر: | Transplantation ; volume 102, issue 12, page 2038-2055 ; ISSN 1534-6080 0041-1337 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health) |
| سنة النشر: | 2018 |
| الوصف: | Background Strategies for successful transplantation are much needed in the era of organ shortage, and there has been a resurgence of interest on the impact of revascularization time (RT) on outcomes in liver transplantation (LT). Methods All primary LT performed in Birmingham between 2009 and 2014 (n = 678) with portal reperfusion first were stratified according to RT (<44 minutes vs ≥44 minutes) and graft quality (standard liver graft [SLG], Donor Risk Index < 2.3 vs marginal liver graft [MLG], Donor Risk Index ≥ 2.3). Results Revascularization time of 44 minutes or longer resulted in significantly greater incidence of early allograft dysfunction (EAD) (29% vs 47%, P < 0.001), posttransplant acute kidney injury (AKI) (39% vs 60%, P < 0.001), and new-onset AKI (37% vs 56%, P < 0.001), along with poor long-term outcome (3-year graft survival 92% vs 83%, P = 0.001; 3-year patient survival 87% vs 79%, P = 0.004). On multivariable analysis, RT ≥ 44 was a significant independent predictor of EAD, renal dysfunction, and overall graft survival, but not patient survival. The cumulative effect of prolonged revascularization in marginal grafts (MLG RT ≥ 44 ) resulted in the worst transplant outcome compared with all other groups, which could be mitigated by rapid revascularization (SLG RT < 44 , SLG RT ≥ 44 , MLG RT < 44 vs MLG RT ≥ 44 ; EAD 24%, 39%, 39% vs 69%; AKI 32%, 46%, 51% vs 70%; 3-year graft survival 94%, 87%, 88% vs 70%, respectively; each P < 0.001). Factors associated with lack of abdominal space, larger grafts, and surgical skills were predictive of RT ≥ 44. Conclusions Shorter graft revascularization is a protective factor in LT, particularly in the setting of graft marginality. Careful graft-recipient matching and emphasis on surgical expertise may aid in achieving better outcomes in LT. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1097/tp.0000000000002263 |
| الإتاحة: | https://doi.org/10.1097/tp.0000000000002263Test https://journals.lww.com/00007890-201812000-00017Test |
| رقم الانضمام: | edsbas.51F49454 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/tp.0000000000002263 |
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