Impact of long-distance (up to 3.500 km) deceased donor liver transportation on cold ischemia time, initial graft function and transplant outcomes

Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task.The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes.Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed.Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p<0.001; transportation time was 3.5 h (interquartile range : 2.5–4.7 h) and 3.5 h (interquartile range: 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p <0.001, in group 1 and group 2, respectively, the difference being statistically significant for all parameters. Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance.Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.