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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of airplane transport of donor livers on post-liver transplantation survival
Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Megan Collins, Albert Nwaba, Linjun Mou, Max K Bulsara, Luc Delriviere, Gary P Jeffrey
Yi Huang, Gerry MacQuillan, Leon A Adams, George Garas, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA 6009, Australia
Gerry MacQuillan, Leon A Adams, George Garas, Megan Collins, Albert Nwaba, Linjun Mou, Luc Delriviere, Gary P Jeffrey, Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
Max K Bulsara, Institute of Health Research, University of Notre Dame, Fremantle, WA 6160, Australia
Author contributions: Huang Y and Jeffrey GP were responsible for study design, data collection and data analysis; Huang Y and Bulsara MK were responsible for statistical analysis of the date; all authors took part in data interpretation, review of the draft report, and content development.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Sir Charles Gairdner Hospital Human Research Ethics Committee.
Conflict-of-interest statement: None of the authors has a conflict of interest.
Informed consent statement: Due to the nature of the study design, no direct contact of participants was required. The informed consent was waived by Sir Charles Gairdner Hospital Human Research Ethics Committee.
Data sharing statement: Additional data are available from the corresponding author at gary.jeffrey@uwa.edu.au.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gary P Jeffrey, MB, BS, MD, FRACP, FRCP, Professor, School of Medicine and Pharmacology, University of Western Australia, 5th Floor, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands, WA 6009, Australia. gary.jeffrey@uwa.edu.au
Telephone: +61-8-93462098 Fax: +61-8-93463098
Received: June 3, 2016
Peer-review started: June 4, 2016
First decision: July 12, 2016
Revised: July 26, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: November 7, 2016
AIM
To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes.
METHODS
A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression.
RESULTS
One hundred and ninety-three patients received a local donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase (mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index (mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time (CIT) (mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance (r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss (HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver (P = 0.027).
CONCLUSION
Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.
Core tip: This study demonstrated a significantly decreased graft and patient survival for patients who received an airplane transported donor liver compared to a local donor liver not requiring airplane transport. The hazard ratio for airplane transported donor livers compared to local donor livers was 1.98 for graft survival and 1.86 for patient survival. The effect of airplane transportation was independent of cold ischemic time.
