Oxygen saturation during donor warm ischemia time and outcome of donation after circulatory death (DCD) liver transplantation with static cold storage: a review of 1114 cases. Journal Article

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Authors: Lee, DD; Joyce, C; Duehren, S; Fernandez, L
Article Title: Oxygen saturation during donor warm ischemia time and outcome of donation after circulatory death (DCD) liver transplantation with static cold storage: a review of 1114 cases.
Abstract: The donor operation and the hemodynamics during declaration resulting in donor warm ischemia time (DWIT) have been linked to the outcomes in donation after circulatory death (DCD) liver transplantation (LT). Scrutiny of the donor hemodynamics at the time of withdrawal of life support (WLS) concluded that a functional donor warm ischemia time (fDWIT) may be associated with LT graft failure. Unfortunately, the definition for fDWIT has not reached consensus - but has almost always incorporated time spent in a hypoxic state. Herein, we reviewed 1114 DCD LT cases performed at the 20 highest volume centers during 2014-2018. Donor hypoxia began within 3 minutes of WLS for 60% of cases and within 10 minutes for 95% of cases. Graft survival was 88.3% at 1 year and 80.3% at 3 years. Scrutinizing the time spent under hypoxic conditions (oxygen saturation = 80%) during the WLS, we found an increasing risk of graft failure as hypoxic time increased from 0-16 minutes. After 16 minutes and up to 50 minutes, we did not find any increased risk of graft failure. In conclusion, after 16 minutes of time in hypoxia, the risk of graft failure in DCD LT did not increase. The current evidence suggests that an over-reliance on hypoxia time may lead to an unnecessary increase in DCD liver discard and may not be as useful for predicting graft loss after LT.
Journal Title: Liver Transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473; 1527-6465
Publisher: Unknown  
Date Published: 2023