Copyright
©The Author(s) 2016.
World J Gastroenterol. Mar 28, 2016; 22(12): 3392-3403
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3392
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3392
Table 1 Donor risk conditions for hypoxic cholangiopathy
| Result | Range | |
| Age | 29.7 ± 10.4 | 9-53 |
| Body mass index (kg/m2) | 25.7 ± 4.1 | 18-36 |
| Pre-op pressors = 0 | 29/44 (65.9%) | |
| Pre-op pressors = 1 | 9/44 (20.5%) | |
| Pre-op pressors ≥ 2 | 6/44 (13.6%) | |
| Red blood cell transfusion | 11/44 (25.03%) | |
| Pre-op hemoglobin (g/dL) | 11.7 ± 2.3 | 4.8-16.5 |
| Pre-op mean arterial pressure (mmHg) | 88.6 ± 17.8 | 57-121 |
| Pre-op SpO2 (%) | 97.3 ± 5.4 | 65-100 |
| Pre-op PaO2 (torr) | 181.9 ± 114.7 | 41-472 |
| Pre-op arterial O2 content (mL/100 mL) | 16.0 ± 3.3 | 7.5-23.2 |
| Donor hypoxia accrual time (min) | 20.8 ± 5.5 | 9.0-33.0 |
| Extubation-to-asystole time (min) | 12.6 ± 5.2 | 4.0-24.0 |
| Asystole-to-aortic clamp time (min) | 8.2 ± 2.4 | 5.0-14.0 |
| Donor ischemia time (min) | 12.4 ± 6.1 | 2-25 |
| Donor hypoxemia time (min) | 14.2 ± 6.1 | 1-29 |
| Donor hypoxia score | 2.3 ± 1.1 | 0.4-4.8 |
| Pre-donation length of stay (d) | 3.8 ± 2.3 | 1-13 |
| No arrest | 24 (53.3%) | |
| Pre-donor duration of arrest (min) | 31.5 ± 20.6 | 3-75 |
Table 2 Hypoxic cholangiopathy correlations with preoperative donor oxygen delivery
| (-) Hypoxic cholangiopathy | (+) Hypoxic cholangiopathy | P value | |
| n | 22 | 22 | |
| Age | 25.6 ± 8.4 | 33.0 ± 10.6 | 0.020 |
| Multiple pressor administration | 27.3% | 0.0% | 0.009 |
| RBC transfusion | 36.4% | 9.5% | 0.040 |
| RBC or multiple pressor administration | 54.6% | 9.5% | 0.001 |
| Hemoglobin | 12.3 ± 2.1 | 10.7 ± 2.2 | 0.020 |
| Arterial O2 content (mL/100 mL) | 16.8 ± 3.3 | 14.8 ± 2.8 | 0.049 |
| Mean arterial pressure (mmHg) | 83.8 ± 18.5 | 92.7 ± 16.2 | 0.100 |
Table 3 Comparison of patients with preoperative multiple pressors or red blood cell transfusion
| (-) Multiple-pressor/RBC | (+) Multiple-pressor/RBC | P value | |
| n | 29 (67.4%) | 14 (32.6%) | |
| Hypoxic cholangiopathy | 19 (65.5%) | 2 (14.3%) | 0.001 |
| Initial pH | 7.33 ± 0.14 | 7.25 ± 0.12 | 0.08 |
| Pre-op pH | 7.43 ± 0.06 | 7.39 ± 0.08 | 0.07 |
| Initial PaO2 | 156.4 ± 84.0 | 133.6 ± 117.6 | 0.48 |
| Pre-op PaO2 | 171.5 ± 106.1 | 191.2 ± 129.8 | 0.60 |
| Initial SpO2 (%) | 97.5 ± 2.7 | 92.2 ± 9.9 | 0.012 |
| Pre-op SpO2 (%) | 97.9 ± 2.0 | 95.9 ± 8.8 | 0.41 |
| Initial P/F O2 | 228.5 ± 116 | 191.4 ± 93 | 0.40 |
| Pre-op P/F O2 | 212.5 ± 101 | 243.8 ± 126 | 0.41 |
| Initial PEEP (cmH2O) | 6.0 ± 2.7 | 5.6 ± 3.9 | 0.69 |
| Pre-op PEEP (cmH2O) | 7.1 ± 4.6 | 7.0 ± 4.5 | 0.96 |
| Pre-op hemoglobin (g/dL) | 11.8 ± 1.9 | 11.8 ± 2.5 | 0.99 |
| Arterial O2 content (mL/100 mL) | 16.2 ± 2.5 | 16.1 ± 4.0 | 0.93 |
| Pre-op systolic pressure (mmHg) | 133.6 ± 21.9 | 123.5 ± 26.8 | 0.19 |
| Pre-op diastolic pressure (mmHg) | 74.3 ± 15.7 | 64.3 ± 18.1 | 0.06 |
| Pre-op mean pressure (mmHg) | 92.1 ± 16.6 | 82.1 ± 19.2 | 0.08 |
| Pre-op heart rate (bpm) | 92.3 ± 20.2 | 96.9 ± 22.3 | 0.49 |
Table 4 Hypoxic cholangiopathy correlations with donor post-extubation hypoxia
| (-) Hypoxic cholangiopathy | (+) Hypoxic cholangiopathy | P value | |
| n | 22 | 22 | |
| Donor hypoxia accrual time (min) | 20.3 ± 5.8 | 21.6 ± 5.2 | 0.470 |
| Extubation-to-asystole time (min) | 12.0 ± 5.1 | 13.4 ± 5.4 | 0.380 |
| Asystole-to-aortic clamp time (min) | 8.3 ± 2.6 | 8.1 ± 2.3 | 0.800 |
| Donor ischemia time (min) | 11.7 ± 7.4 | 13.5 ± 4.2 | 0.340 |
| Donor hypoxemia time (min) | 13.2 ± 6.5 | 15.5 ± 5.6 | 0.220 |
| Preoperative hemoglobin (g/dL) | 12.3 ± 2.1 | 10.7 ± 2.2 | 0.017 |
| Donor hypoxia score | 2.0 ± 1.2 | 2.7 ± 0.9 | 0.030 |
| Donor hypoxia score > 2.0 | 25.0% | 69.6% | 0.006 |
Table 5 Recipient risk variables - n = 45 n (%)
| Result | Range | |
| Hepatitis-C | 13 (28.9) | |
| Ethanol | 6 (13.3) | |
| Alpha-1 antitrypsin | 9 (20.0) | |
| Hepatitis B | 3 (6.7) | |
| Hepatocellular carcinoma | 18 (40.0) | |
| ≥ 2 diagnoses | 21 (46.7) | |
| MELD | 28.7 ± 5.6 | 17-40 |
| Duct to duct anastamosis | 38 (84.4) | |
| Cold-ischemia time (min) | 429.9 ± 127.3 | 60-660 |
| Warm-ischemia time (min) | 35.4 ± 13.6 | 16-76 |
| Total-ischemia time (min) | 465.6 ± 131.0 | 95-688 |
Table 6 Era 1 and era 2 risk comparisons
| Era 1 | Era 2 | P value | |
| DCD liver transplants | 17 | 27 | |
| Hypoxic cholangiopathy | 29.4% | 63.0% | 0.030 |
| Transplants per year | 2.5 | 7.1 | 0.100 |
| Hepatocellular carcinoma | 23.5% | 51.9% | 0.060 |
| Donor body mass index (kg/m2) | 24.1 ± 3.1 | 26.7 ± 4.3 | 0.030 |
| Donor hypoxia accrual time (min) | 17.3 ± 5.0 | 22.7 ± 4.8 | 0.001 |
| Donor extubation-to-asystole time (min) | 9.3 ± 4.5 | 14.4 ± 4.7 | 0.001 |
| Donor aystole-to-crossclamp time (min) | 8.1 ± 2.7 | 8.3 ± 2.3 | 0.779 |
| Donor ischemia time (min) | 9.7 ± 5.6 | 13.9 ± 5.9 | 0.030 |
| Donor hypoxemia time (min) | 11.1 ± 6.7 | 16.0 ± 5.1 | 0.013 |
| Donor hypoxia score | 1.6 ± 0.9 | 2.7 ± 1.1 | 0.003 |
| Donor hypoxia score > 2.0 | 28.6% | 73.1% | 0.006 |
| Recipient cold ischemia time (min) | 381 ± 139 | 461 ± 111 | 0.040 |
| Recipient warm ischemia time (min) | 31 ± 10 | 39 ± 15 | 0.030 |
| Recipient total ischemia time (min) | 411.8 ± 135 | 499.4 ± 119 | 0.030 |
- Citation: Chirichella TJ, Dunham CM, Zimmerman MA, Phelan EM, Mandell MS, Conzen KD, Kelley SE, Nydam TL, Bak TE, Kam I, Wachs ME. Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy. World J Gastroenterol 2016; 22(12): 3392-3403
- URL: https://www.wjgnet.com/1007-9327/full/v22/i12/3392.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i12.3392