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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Shortening the recipient warm ischemia time could be a strategy for expanding the liver donor pool
Jia-Wei Yu, Lin-Biao Xiang, Xiao-Juan Dong, Chen-Xi Yang, Lei Wang, Xiao-Yu Liu, Yi-Hong Song, Xian-Jie Bai, Jing-Wen Xiao, Lu Ren, Qin-Hong Xu, Gang-Hua Yang, Yi Lv, Qiang Lu
Jia-Wei Yu, Lin-Biao Xiang, Xiao-Juan Dong, Chen-Xi Yang, Lei Wang, Xiao-Yu Liu, Yi-Hong Song, Xian-Jie Bai, Jing-Wen Xiao, Yi Lv, Qiang Lu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jia-Wei Yu, Lin-Biao Xiang, Xiao-Juan Dong, Chen-Xi Yang, Lei Wang, Xiao-Yu Liu, Yi-Hong Song, Xian-Jie Bai, Jing-Wen Xiao, Yi Lv, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Lu Ren, Department of International Medical Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Qin-Hong Xu, Gang-Hua Yang, Qiang Lu, Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Co-corresponding authors: Yi Lv and Qiang Lu.
Author contributions: Lv Y and Lu Q designed and supervised the study; Yu JW, Xiang LB, Dong XJ, Yang CX, Wang L, Liu XY, Song YH, Bai XJ, Xiao JW, and Lu Q performed the research and acquired the data; Yu JW and Xu QH were responsible for data extraction and analysis; Yu JW, Ren L, and Yang GH were responsible for writing the manuscript; Lv Y and Lu Q contributed equally to this work. All the authors have read and approved the final manuscript.
Supported by The Key R&D Plan of Shaanxi Province, No. 2021GXLH-Z-047.
Institutional animal care and use committee statement: The Ethics Committee of Animal Experiments at Xi’an Jiaotong University approved this study. All experiments complied with the Animal Research: Reporting of In Vivo Experiments guidelines and were performed following the National Institutes of Health Guide for the Care and Use of Laboratory Animals (NIH Publication No. 8023, revised 1978).
Conflict-of-interest statement: All the authors declare that there are no financial and other conflicts of interest in relation to this study.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Data sharing statement: sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
luqiang2020@xjtufh.edu.cn. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Qiang Lu, MD, PhD, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 76 West Yanta Road, Xi’an 710061, Shaanxi Province, China.
luqiang2020@xjtufh.edu.cn
Received: November 12, 2024
Revised: January 3, 2025
Accepted: January 20, 2025
Published online: March 7, 2025
Processing time: 99 Days and 2.5 Hours
BACKGROUND
Shortening the recipient warm ischemia time (rWIT) has been proven to be effective for improving the short- and long-term outcomes after liver transplantation (LT) and offsets the negative impact of an extended cold ischemia time. However, few studies have been conducted to explore the prognostic effects of shortening the rWIT in transplantations using a liver graft from an extended-criteria donor (ECD).
AIM
To investigate whether shortening the rWIT could improve the outcomes of ECD LT.
METHODS
Rat ECD autologous orthotopic LT were performed with variable rWITs (0, 10, 20, and 30 minutes). Near-infrared fluorescence imaging (FI) was used for the real-time assessment of liver graft ischemia-reperfusion injury after the anhepatic phase. Survival was assessed, and liver function and histological analyses were performed on the third day after transplantation.
RESULTS
The FI curve growth rate and postoperative three-day survival rate significantly increased, and the liver function and Suzuki score of the liver grafts significantly improved when the rWIT was ≤ 10 minutes (P < 0.05).
CONCLUSION
The post-transplant outcomes were significantly better with a shorter rWIT (10 minutes or less) than with a longer rWIT, which could be a strategy for expanding the liver donor pool.
Core Tip: Shortening the recipient warm ischemia time (rWIT) can eliminate the negative impact of an extended cold ischemia time. Therefore, this study assessed the effect of shortening the rWIT on the outcomes of liver transplantation using extended-criteria donor (ECD) liver grafts in rats. The fluorescence imaging curve growth rate and postoperative 3-day survival rate significantly increased, and the liver function and Suzuki score of the liver grafts improved when the rWIT was ≤ 10 minutes. Therefore, using ECD liver grafts while shortening the rWIT could be a strategy for expanding the liver donor pool in humans.
