Influence of ischemia and surgery times on development of primary dysfunction liver transplant in patients

Abstract Objectives (1) To determine the incidences of primary failure and primary dysfunction of liver transplants performed at our center. (2) To evaluate the effects of mean cold and warm ischemia times as well as the length of five stages of surgery on the development of primary dysfunction. Patients and methods We reviewed 248 liver transplants consecutively performed in 206 patients at the Hospital Ramon y Cajal, Madrid over 79 months. Six cases were excluded because the patients died within 24 hours of transplant, it was therefore not possible to establish the postoperative liver function. Recipients were classified according to their posttransplant liver function as showing normal primary function (NP) or primary dysfunction (PD), which included patients with primary failure (PF) and inadequate primary function (IPF). The NP and IPF groups were defined in terms of transaminase levels and prothrombin activity from posttransplant days 2 to 7. The following factors were analyzed: graft cold (CIT) and warm (WIT) ischemia times; graft arterial (AIT) and venous (VIT) ischemia times; and times of surgery (ST), arterial anastomosis (AAT), and anhepatic phase (APT). Results Twenty-three (9.3%) patients were classified as showing PD, 12 (4.8%) of whom suffered an episode of PF. The mean values (and standard deviations) of the times (in minutes) were ST = 308.19 ± 109.78; CIT = 411.08 ± 140.62; WIT = 46.51 ± 37.70; AIT = 510.95 ± 165.95; VIT = 458.68 ± 151.98; AAT = 54.12 ± 31.84; and APT = 58.53 ± 90.07. No significant differences were detected in the mean times of patients showing NP or PD. Neither were any differences observed between the two patient groups according to the variables CIT longer than 10 hours and WIT longer than 60 minutes. Conclusion Our times of surgery and cold ischemia are shorter than those reported by other transplant teams, mostly North American surgeons who quote figures of around 7 and 12 hours, respectively. These relatively low values may account for the lack of effect shown by the times of ischemia or surgery stages on the appearance of primary dysfunction in patients undergoing liver transplant.