Impact of Donor Hepatectomy Time during Organ Procurement in Donation after Circulatory Death Liver Transplantation: The United Kingdom Experience

Background No data exists to evaluate how hepatectomy time (HT), in the context of donation after cardiac death (DCD) procurement, impacts on short and long-term outcomes following liver transplantation (LT). In this study we analyse the impact of the time from aortic perfusion to end of hepatectomy on outcomes following DCD LT in the UK. Methods An analysis of 1112 DCD donor LT across all UK transplant centres between 2001 and 2015 was performed, using data from the UK Transplant Registry. Donors were all Maastricht Category III. Graft survival after transplantation was estimated using Kaplan-Meier method and logistic regression to identify risk factors for PNF and short and long-term graft survival after LT. Results Incidence of PNF was 4% (40) and in multivariate analysis only CIT >8 hrs. (HR 2.186 (1.113-4.294, p=0.023) and HT > 60 mins (HR 3.669 (1.363-9.873, p=0.01) were correlated with PNF. Overall 90-day, 1 year, 3 year and 5 year graft survival in DCD LT was 91.2%, 86.5%, 80.9% and 77.7% (compared to a DBD cohort in the same period (n=7221) 94%, 91%, 86.6%, and 82.6% respectively (p 60mins, donor age >45 yrs., CIT> 8 hours and recipient previous abdominal surgery. Conclusions There is a negative impact of prolonged HT on outcomes on DCD LT and although HT > 60 mins is not a contraindication for utilisation it should be part of a multifactorial assessment with established prognostic donor factors such as age (>45yrs) and CIT (>8hrs) for an appropriately selected recipient. No conflicts of interest Correspondence: Mr. Shahid Farid, Consultant Transplant Surgeon, Department of Transplantation, St James University Hospital, Beckett Street, Leeds, United Kingdom, LS9 7TF. s.farid@nhs.net Authorship Page: SG Farid: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. MS Attia: Participated in research design and final review of the paper. D Vijayanand: Participated in research design, writing and final review of the paper. V Upasani: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. S Willis: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. A Barlow: Participated in the writing and final review of the paper. E Hidalgo: Participated in research design, performance of the research, writing and final review of the paper. N Ahmad: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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