Impact of Liver Graft Transport on Postoperative Results and Short-Term Liver Survival.

Abstract

The Andalusian community has a specific management model of liver transplantation with a common waiting list, forcing transportation of 45% of hepatic grafts. These trips within the community have been made exclusively via expressway since 2012, sometimes surpassing 400 km in distance. The objective of this study was to analyze the effect of graft transportation on our community regarding postoperative results, primary dysfunction, and short-term graft survival. This was a retrospective observational cohort study that included 110 patients recipients of liver transplants from 2009 to 2012. Group A (n= 53) were patients transplanted with grafts removed in Malaga, and group B (n= 57) were patients with transported grafts. In group B, significant increments in total and cold ischemia time (TIT and CIT) were found. We found a significant higher increase, mostly in 2012, in TIT and CIT in the greater transportation distance subgroup (>150 km). In postoperative variables analysis, differences were found in the bilirubin levels the 1st postoperative day, alkaline phosphatase levels the 1st and 3rd days, and factor V in the 1st day in favor of the nontransported grafts. In the multivariable analysis transport and distance travelled in km presented a relationship with the 1st day bilirubin levels and the primary dysfunction of the graft. Our results point to graft transportation having an influence on primary dysfunction and graft survival. This relationship can be multifaceted and influenced by currently unknown factors. This is a factor to consider regarding liver transplant management strategy decisions.