Abstract
IntroductionThe ability to preserve organs prior to transplant is essential to the organ allocation process.ObjectiveThe purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant.MethodsTo identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance.ResultsTwenty-six studies met criteria. Functionally, PNF% = −6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean−9.89535)2−0.0067663*(CIT Mean−9.89535)3, r2 = .625, , p<.0001. Mean patient survival: 93 % (1 month), 88 % (3 months), 83 % (6 months) and 83 % (12 months). Mean graft survival: 85.9 % (1 month), 80.5 % (3 months), 78.1 % (6 months) and 76.8 % (12 months). Maximum patient and graft survival occurred with CITs between 7.5–12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches.ConclusionThe results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ.
Highlights
The ability to preserve organs prior to transplant is essential to the organ allocation process
The results of this work imply that cold-ischemia time (CIT) may be the most important pre-transplant information needed in the decision to accept an organ
Using chi statistic to test for heterogeneity of primary nonfunction (PNF) within the CIT intervals, we find there is low heterogeneity for intervals under 7.5 hours and increasing heterogeneity and fewer studies as we move to the tail of the PNF vs CIT distribution: For the CIT interval 0–2.5 hrs the p value for Chi2 was .95 and I2 was 24.9, for the CIT interval 2.5–5 hrs the p value for Chi2 was .95 and I2 was 36.6, for the CIT interval 5–7.5 hrs the p value for Chi2 was .95 and I2 was 36.6, for the CIT interval 7.5–10 hrs the p value for Chi2 was .94 and I2 was 81, for the CIT interval 10 . hrs the p value for Chi2 was .94 and I2 was 95.6
Summary
The ability to preserve organs prior to transplant is essential to the organ allocation process. Procuring and transplanting organs are the two main functions of the liver allocation system. Preserving livers until they can be transplanted is an essential intermediate step. The U.S Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients, has recently has begun to publish the effect of cold-ischemia time (the time from clamping of the donor aorta until the anastomosis of the organ to the recipients vascular system or the organs disposal) on clinical outcomes- patient and graft survival [1]. Coldischemia time determines in part how far we can transport organs [13]. This in turn influences the size of the pool of organs available to patients [14]. Understanding the effectiveness of organ preservation technology is important in understanding how best to allocate organs
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