Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Association of donor hepatectomy time with liver transplantation outcomes: A multicenter retrospective study
Geisiane Custodio, Andrew Maykon Massutti, Aline Caramori, Taynara Gonçalves Pereira, Augusto Dalazen, Gabriela Scheidt, Ludmilla Thomazini, Cristiane Bauermann Leitão, Tatiana Helena Rech
Geisiane Custodio, Department of Intensive Care Unit, Hospital Santa Isabel, Blumenau-Santa Catarina CEP-89010906, Brazil
Andrew Maykon Massutti, Aline Caramori, Taynara Gonçalves Pereira, Augusto Dalazen, Transplant Division, Hospital Santa Isabel, Blumenau-Santa Catarina CEP-89010906, Brazil
Gabriela Scheidt, School of Medicine, Universidade Regional de Blumenau (FURB), Blumenau-Santa Catarina CEP-89010906, Brazil
Ludmilla Thomazini, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
Cristiane Bauermann Leitão, Departement of Endocrinology, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
Tatiana Helena Rech, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Division of Intensive Care Medicine, Porto Alegre 90035-903, Brazil
Author contributions: Custodio G participated in the study design, collection and interpretation of data, statistical analysis, and drafting of the manuscript; Massutti AM and Caramori A performed all liver transplantations; Pereira TG, Dalazen A, Scheidt G, and Thomazini L were involved in data collection; Leitão CB participated in the study conception and design, interpretation of data, and statistical analysis; Rech T contributed to the study conception and design, interpretation of data, statistical analysis, and drafting the manuscript; All authors reviewed and edited the manuscript. Rech TH is the guarantor of this work and, as such, had complete access to all data, with full responsibility for the integrity of the data and accuracy of analysis.
Institutional review board statement: The study was approved by the reference Ethics Committee at the Universidade Federal Rio Grande do Sul (PROPESQ UFRGS, project No. 5.526.176), Brazil. The study adheres to the guidelines set forth by the Helsinki Declaration, as well as to local standards and Brazilian legislation.
Informed consent statement: The Ethics Committee did not require informed consent due to the retrospective design and the anonymization of donors and recipients prior to analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Consent was not obtained, but the potential benefits of sharing this data outweigh the potential harms, as it may bring improvement to transplant patients and not pose a direct risk to patients. The Term of Commitment for Data Usage used will be attached. Available in Geisiane_c@yahooo.com.br.
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: Geisiane Custodio, PhD, Attending Doctor, Professor, Researcher, Department of Intensive Care Unit, Hospital Santa Isabel, Rua Floriano Peixoto 300, Centro, Blumenau-Santa Catarina CEP-89010906, Brazil. geisiane_c@yahoo.com.br
Received: November 9, 2023
Peer-review started: November 9, 2023
First decision: November 29, 2023
Revised: December 13, 2023
Accepted: January 12, 2024
Article in press: January 12, 2024
Published online: March 18, 2024
ARTICLE HIGHLIGHTS
Research background
To address the shortage of organs and improve liver transplantation outcomes, it is crucial to explore opportunities to enhance donor, graft, and recipient care. One such method involves reducing the duration of ischemic phases, which has been demonstrated to be of great importance.
Research motivation
There is a need for policies and interventions to improve post-transplant results, it appears that the donor's hepatectomy time may be a factor contributing to this improvement.
Research objectives
This study aimed to evaluate the impact of donor hepatectomy timing on outcomes in liver transplant recipients, particularly early allograft dysfunction. We know that transplantation is a race against time, and better understanding the importance of these times is essential for a more accurate strategy.
Research methods
This is a multicenter retrospective study. The study included brain-dead donors from 19 regional centers in the state of Santa Catarina, Brazil, and adult liver transplant recipients from brain-dead donors at Hospital Santa Isabel, a general hospital in the city of Blumenau, state of Santa Catarina, Brazil, from January 2019 to December 2021. The discriminative power of donor hepatectomy time to predict the outcome was determined by analyzing receiver operating characteristic curves, and patients were divided into two groups: Below and above the cutoff.
Research results
In this multicenter retrospective study involving liver recipients from brain-dead donors, we did not find any evidence of an association between donor hepatectomy time and the development of early allograft dysfunction. Furthermore, our findings indicate that longer hepatectomy times did not affect either graft or patient survival. We believe that the exceptionally short median donor hepatectomy time of < 29 min in our study, along with the absence of prolonged warm ischemia typical of donors after cardiac death, explains the lack of association between donor hepatectomy time and outcomes in our cohort of brain-dead donors.
Research conclusions
Donor hepatectomy times did not affect either graft or patient survival. The new methods that this study proposed was to evaluate hepatectomy time in centers where this time is already reduced in relation to other centers already studied.
Research perspectives
While there is a need for policies and interventions to enhance post-transplant outcomes, it appears that the current donor hepatectomy time is already sufficiently short to further mitigate risks. We suggest that future research efforts should focus on exploring alternative strategies other than further reducing donor hepatectomy times.
