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Warm Ischemia Time

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Donation after Circulatory Death (DCD) Liver Transplantation

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Abstract

Donation after circulatory death (DCD) donors differ from donation after brain death (DBD) donors in that they experience a period of obligatory donor warm ischemia time (DWIT) prior to initiation of cold perfusion of organs. While most authors agree that prolonged DWIT results in hepatic ischemic injury, debate exists on the length of DWIT or hemodynamic parameters following withdrawal of life support that determine whether a liver graft can be used with reasonable safety. As such, the concept of a functional warm ischemia time (f-DWIT) arose from the notion that individual events during DCD procurement, such as variations in hemodynamics, mandatory wait period, and time from incision to cannulation of the aorta and cross clamp, all of which are included in total DWIT, may have different impact on the outcome of the liver graft. The present chapter reviews the various definitions relevant to warm ischemia time in liver transplantation using DCD donors in an attempt to clarify the existing ambiguity. The chapter also provides a comprehensive view of the literature by describing studies that have investigated various parameters of warm ischemia time and their associations with outcomes following liver transplant using DCD donors, such as graft failure and ischemic cholangiopathy (IC). Finally the chapter reviews potential reasons for the variability in previous studies as well as discusses the limitations associated with using various hemodynamic parameters to evaluate hepatic ischemic injury.

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References

  1. Ho KJ, Owens CD, Johnson SR, Khwaja K, Curry MP, Pavlakis M, Mandelbrot D, Pomposelli JJ, Shah SA, Saidi RF, Ko DS, Malek S, Belcher J, Hull D, Tullius SG, Freeman RB, Pomfret EA, Whiting JF, Hanto DW, Karp SJ. Donor postextubation hypotension and age correlate with outcome after donation after cardiac death transplantation. Transplantation. 2008;85(11):1588–94.

    Article  Google Scholar 

  2. de Vera ME, Lopez-Solis R, Dvorchik I, Campos S, Morris W, Demetris AJ, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant. 2009;9:773–81.

    Article  Google Scholar 

  3. Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant. 2006;6:791–6.

    Article  CAS  Google Scholar 

  4. Firl DJ, Hashimoto K, O’Rourke C, Diago-Uso T, Fujiki M, Aucejo FN, et al. Role of donor hemodynamic trajectory in determining graft survival in liver transplantation from donation after circulatory death donors. Liver Transpl. 2016;22:1469–81.

    Article  Google Scholar 

  5. Taner CB, Bulatao IG, Perry DK, et al. Asystole to cross- clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int. 2012;25:838–46.

    Article  Google Scholar 

  6. Perera MT. The super-rapid technique in Maastricht category III donors: has it developed enough for marginal liver grafts from donors after cardiac death? Curr Opin Organ Transplant. 2012;17(2):131–6.

    Article  Google Scholar 

  7. Laing RW, Scalera I, Isaac J, Mergental H, Mirza DF, Hodson J, Wilkin RJ, Perera MT, Muiesan P. Liver transplantation using grafts from donors after circulatory death: a propensity score-matched study from a single center. Am J Transplant. 2016;16(6):1795–804.

    Article  CAS  Google Scholar 

  8. Oliver TI, Sadiq U, Grossman SA. Pulseless electrical activity. StatPearls [Internet]. Treasure Island, StatPearls Publishing; 2019–2019.

    Google Scholar 

  9. Rhee JY, Alroy J, Freeman RB. Characterization of the withdrawal phase in a porcine donation after the cardiac death model. Am J Transplant. 2011;11:1169–75.

    Article  CAS  Google Scholar 

  10. Reich DJ, Mulligan DC, Abt PL, Pruett TL, Abecassis MM, D’Alessandro A, Pomfret EA, Freeman RB, Markmann JF, Hanto DW, Matas AJ, Roberts JP, Merion RM, Klintmalm GB. ASTS Standards on Organ Transplantation Committee. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant. 2009;9(9):2004–11.

    Article  CAS  Google Scholar 

  11. Dondossola D, Lonati C, Zanella A, Maggioni M, Antonelli B, Reggiani P, Gatti S, Rossi G. Preliminary experience with hypothermic oxygenated machine perfusion in an Italian Liver Transplant Center. Transplant Proc. 2019;51(1):111–6.

    Article  CAS  Google Scholar 

  12. Lee KW, Simpkins CE, Montgomery RA, Locke JE, Segev DL, Maley WR. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation. 2006;82:1683–8.

    Article  Google Scholar 

  13. Mathur AK, Heimbach J, Steffick DE, Sonnenday CJ, Goodrich NP, Merion RM. Donation after cardiac death liver transplantation: predictors of outcome. Am J Transpl. 2010;10:2512.

    Article  CAS  Google Scholar 

  14. Kubal C, Mangus R, Fridell J, Saxena R, Rush N, Wingler M, Ekser B, Tector J. Optimization of perioperative conditions to prevent ischemic cholangiopathy in donation after circulatory death donor liver transplantation. Transplantation. 2016;100(8):1699–704.

    Article  CAS  Google Scholar 

  15. Bernat JL, D AM, Port FK, Bleck TP, Heard SO, Medina J, et al. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6(2):281–91.

    Article  CAS  Google Scholar 

  16. Transplantation from deceased donors after circulatory death: British Transplant Society Guidelines. https://bts.org.uk/wp-content/uploads/2016/09/15_BTS_Donors_DCD-1.pdf. Accessed 10 Feb 2020.

  17. Eurotransplant. Eurotransplant Manual – Chapter 9. The Donor. 2016.

    Google Scholar 

  18. Abradelo de Usera M, Blasi Ibáñez A, Fundora Suárez Y, Fondevila Campo C, Gómez Gutiérrez M, Sánchez Turrión V. Protocolo nacional de donación y trasplante hepático en donación en asistolía controlada. 2015.

    Google Scholar 

  19. Chan EY, Olson LC, Kisthard JA, et al. Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl. 2008;14:604–10.

    Article  Google Scholar 

  20. Hong JC, Yersiz H, Kositamongkol P, et al. Liver transplantation using organ donation after cardiac death: a clinical predictive index for graft failure- free survival. Arch Surg. 2011;146:1017–23.

    Article  Google Scholar 

  21. Doyle MB, Collins K, Vachharajani N, Lowell JA, Shenoy S, Nalbantoglu I, Byrnes K, Garonzik-Wang J, Wellen J, Lin Y, Chapman WC. Outcomes using grafts from donors after cardiac death. J Am Coll Surg. 2015;221(1):142–52.

    Article  Google Scholar 

  22. Kalisvaart M, de Haan JE, Polak WG, N M IJzermans J, Gommers D, Metselaar HJ, de Jonge J. Onset of donor warm ischemia time in donation after circulatory death liver transplantation: hypotension or hypoxia? Liver Transpl. 2018;24(8):1001–10.

    Article  Google Scholar 

  23. Coffey JC, Wanis KN, Monbaliu D, Gilbo N, Selzner M, Vachharajani N, Levstik MA, Marquez M, Doyle MBM, Pirenne J, Grant D, Heimbach JK, Chapman W, Vogt K, Hernandez-Alejandro R. The influence of functional warm ischemia time on DCD liver transplant recipients’ outcomes. Clin Transplant. 2017;31(10). doi: 10.1111/ctr.13068. Epub 2017.

  24. Schlegel A, Kalisvaart M, Scalera I, Laing RW, Mergental H, Mirza DF, Perera T, Isaac J, Dutkowski P, Muiesan P. The UK DCD risk score: a new proposal to define futility in donation-after-circulatory-death liver transplantation. J Hepatol. 2018;68(3):456–64.

    Article  Google Scholar 

  25. Abt P, Praestgaard J, West S, Hasz R. Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation. Liver Transpl. 2014;20:165–72.

    Article  Google Scholar 

  26. Foley DP. Impact of donor warm ischemia time on outcomes after donation after cardiac death liver transplantation. Liver Transpl. 2014;20(5):509–11.

    Article  Google Scholar 

  27. Rhee JY, Ruthazer R, O’Connor KO, Delmonico FL, Luskin RS, Freeman RB. The impact of variation in donation after cardiac death policies among donor hospitals: a regional analysis. Am J Transpl. 2011;11:1719.

    Article  CAS  Google Scholar 

  28. Rutherford K. Principles and application of oximetry. Crit Care Nurs Clin North Am. 1989;1:649–57.

    Article  CAS  Google Scholar 

  29. Farid SG, Attia MS, Vijayanand D, Upasani V, Barlow AD, Willis S, Hidalgo E, Ahmad N. Impact of donor hepatectomy time during organ procurement in donation after circulatory death liver transplantation: the United Kingdom experience. Transplantation. 2019;103(4):e79–88.

    Article  Google Scholar 

  30. Khorsandi S, et al. Developing a donation after cardiac death risk index for adult and pediatric liver transplantation. World J Transpl. 2017;7(3):203–12. https://doi.org/10.5500/wjt.v7.i3.203.

    Article  Google Scholar 

  31. van Leeuwen O, van Reeven M, Fujiyoshi M, de Meijer VE, de Kleine R, de Boer M, de Jonge J, Ijzermans J, Polak W, Porte R. Donor hepatectomy time in donation after circulatory death donors is an independent risk factor for the development of biliary strictures and early graft loss after transplantation. Am J Transpl. 2018;18(S4):572–73.

    Google Scholar 

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Authors and Affiliations

  1. Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA

    Kristopher P. Croome & C. Burcin Taner

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  1. Kristopher P. Croome
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  2. C. Burcin Taner
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Correspondence to C. Burcin Taner .

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Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, FL, USA

    Kristopher P. Croome

  2. Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Paolo Muiesan

  3. Department of Transplant, Mayo Clinic, Jacksonville, FL, USA

    C. Burcin Taner

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Croome, K.P., Taner, C.B. (2020). Warm Ischemia Time. In: Croome, K., Muiesan, P., Taner, C. (eds) Donation after Circulatory Death (DCD) Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-030-46470-7_5

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  • DOI: https://doi.org/10.1007/978-3-030-46470-7_5

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  • Print ISBN: 978-3-030-46469-1

  • Online ISBN: 978-3-030-46470-7

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