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

• Published in: The American journal of surgery Vol. 228; pp. 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: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2024; Elsevier Limited
• Subjects: Blood & organ donations; Body mass index; Body size; Cold storage; Cryopreservation; Graft rejection; Grafting; Health hazards; Independent variables; Intervention; Ischemia; Liver; Liver diseases; Liver transplantation; Liver transplants; Mortality; Patients; Perfusion; Portal vein; Rank tests; Thromboembolism; Thrombosis; Veins & arteries; United States > US; Alaska
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2023.09.026

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.