Portal vein thrombosis and donation after cardiac death liver transplantation: Pre-perfusion data implications for the perfusion era

The log-rank test was used to compare the outcomes based on PVT extent, as described by the Yerdel classification.4 Evaluation of the effect of donor type and PVT extent on overall and graft failure free survival in the context of other relevant clinical factors was performed using a multivariable C...

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Bibliographic Details
Published in:The American journal of surgery 2024-02, Vol.228, p.301-304
Main Authors: Zhang, Chi, Calderon, Esteban, Chang, Yu-Hui, Lu, Patricia, Durant, Adri M., Villa, Efren Luque, Katariya, Nitin N., Jadlowiec, Caroline, Reddy, Kunam S., Moss, Adyr, Mathur, Amit K.
Format: Article
Language:English
Subjects:
Blood & organ donations
Body mass index
Body size
Cold storage
Cryopreservation
Death
Graft rejection
Grafting
Health hazards
Humans
Independent variables
Intervention
Ischemia
Liver
Liver Diseases
Liver Transplantation
Liver transplants
Mortality
Patients
Perfusion
Portal Vein
Rank tests
Thromboembolism
Thrombosis
Veins & arteries
Venous Thrombosis
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Summary:The log-rank test was used to compare the outcomes based on PVT extent, as described by the Yerdel classification.4 Evaluation of the effect of donor type and PVT extent on overall and graft failure free survival in the context of other relevant clinical factors was performed using a multivariable Cox proportional-hazards model. Independent variables included age, race, donor and recipient body mass index (BMI), Model for End-Stage Liver Disease (MELD) at transplant, LT indication, cold ischemia time (CIT), and number of PRBC units transfused. The hazard ratio (HR) and 95% confidence interval were reported. Perhaps the most important finding in this analysis is that DCD grafts can safely be utilized in a liver transplant candidate with PVT. DCD organ donation is rising precipitously, and PVT patients cannot always compete for DBD grafts due to frequently lower relative MELD scores.7 While we have adopted the use of mechanical perfusion in our program, the present cohort demonstrates safety in utilizing DCD grafts for PVT patients with the use of static cold storage and does not introduce biases related to the benefits of machine perfusion, as machine perfusion is still somewhat nascent with many transplant centers still in the process of acquiring access due to financial and staffing caveats.
ISSN:0002-9610
1879-1883
1879-1883
DOI:10.1016/j.amjsurg.2023.09.026