Synergistic effect of cold and warm ischemia time on postoperative graft function and outcome in human liver transplantation

Abstract

Prolonged cold ischemia time (CIT) during graft preservation and warm ischemia time (WIT)during rewarming time have been reported to cause postoperative graft dysfunction afterorthotopic liver transplantation (OLT). However, the effects of both CIT and WIT in combination onpatient and graft survivals are not yet defined. The aim of this study was to determinewhether simultaneously prolonged CIT and WIT were associated with early graft outcomes afterclinical OLT. For analysis of liver graft survival within 90 days of OLT and postoperative graftfunction, 186 consecutive OLT cases weredivided into four groups as follows: group A, CIT < 12 hours and WIT < 45 minutes; group B, CIT > 12hours and WIT < 45 minutes; group C, CIT < 12 hours and WIT > 45 minutes; and group D, CIT > 12 hoursand WIT > 45 minutes.The graft loss rates were 5.4% in group A, 9.8% in group B, 11.1% ingroup C, and 42.9% in group D. The mean highest aspartate aminotransferase (AST) valueafter OLT in group D (3352.3 ± 569.4 U/L) was significantly greater than those in groups A(1411.7 ± 169.2 U/L) and B (1931.3 ± 362.6 U/L). The simultaneously prolonged cold andwarm ischemia times significantly caused hepatic allograft injury and failure, suggesting somecumulative effects of CIT and WIT on postoperative graft function.