Association of donor hepatectomy time with liver transplantation outcomes: A multicenter retrospective study

Table 1 Baseline characteristics of the donors, recipients, and surgical procedures, n (%)

Donor characteristics	Values
Demographics
Age (yr)	41 ± 14
Men	150 (62)
BMI (kg/m2)	25.5 ± 3.5
Cause of death
Stroke	118 (48.6)
Traumatic brain injury	96 (39.5)
Anoxic encephalopathy	19 (7.8)
Others	10 (4.1)
Organ Procurement
Regional	215 (88.5)
Local	28 (11.5)
Disease severity
Time on MV before donation (d)	4 (3-7)
Presence of sepsis	125 (51.4)
Need for vasopressors	201 (82.7)
Cardiac arrest	48 (19.8)
Biochemical measurements
ALT (U/L)	29 (19-62)
AST (U/L)	40 (24-70)
Bilirubin (mg/dL)	0.5 (0.3-0.8)
Creatinine (mg/dL)	1 (0.7-1.4)
Sodium (mEq/L)	148 ± 10
Platelets (10³/mm³)	158 (106-212)
Blood glucose (mg/dL)	243 ± 91
Recipients’ characteristics	Values
Demographics
Age (yr)	56 ± 11
Men	175 (72)
BMI (kg/m2)	27.8 ± 4.8
Blood group
O	89 (36.6)
A	108 (44.5)
B	34 (14)
AB	11 (4.5)
Indications for liver transplantation
Viral hepatitis	78 (32)
Alcoholic liver disease	63 (26)
Non-alcoholic steatohepatitis	29 (12)
Cryptogenic	23 (9.5)
Others	50 (20.5)
Disease severity
MELD score	20 ± 8
Presence of HCC	92 (38)
Previous abdominal surgery	88 (36.2)
Previous decompensation	153 (63)
Biochemical measurements
ALT (U/L)	611 (375-1041)
AST (U/L)	1055 (580-1829)
Bilirubin (mg/dL)	4 (2.3-6.2)
Creatinine (mg/dL)	0.9 (0.7-1.2)
Platelets (10³/mm³)	105 (67-142)
INR	2.1 (1.7-2.7)
Albumin (g/dL)	2.6 (2.3-2.9)
Surgical procedures
Cold ischemia time (min)	405 (329-492)
Warm ischemia time (min)	34 (30-37)
Donor hepatectomy time (min)	29 (23-40)
Need for thrombectomy	33 (13.6)
Need for arterial reconstruction	31 (12.8)

BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; MELD: Model of end-stage liver disease; MV: Mechanical ventilation; HCC: Hepatocellular carcinoma; INR: International normalized ratio. Values are mean ± SD or median and interquartile range.

Table 2 Association between donor, recipients, and surgical procedures with the development of early allograft dysfunction, n (%)

	All patients (n = 228)	With EAD (n = 57)	Without EAD (n = 171)	P value
Donors’ characteristics
Age (yr)	41 ± 14	43 ± 14	40 ± 14	0.186
BMI (kg/m2)	25.5 ± 3.6	26 ± 4.1	25.3 ± 3.5	0.286
Need for vasopressors	187 (82)	44 (77.2)	143 (8.6)	0.273
Time on MV before donation (d)	4 (3-7)	5 (4-11)	4 (3-7)	0.001
Cardiac arrest	41 (18)	14 (24.6)	27 (15.8)	0.135
DRI score	1.3 (1.1-1.6)	1.3 (1.1-1.5)	1.4 (1.1-1.7)	0.224
Recipients’ characteristics
Age (yr)	56 ± 11	53 ± 13	58 ± 10	0.021
BMI (kg/m2)	27.7 ± 4.8	28.9 ± 5.9	27.4 ± 4.1	0.112
Indication for transplantation				0.079
Alcoholic liver disease	62 (27.2)	13 (22.8)	49 (28.7)
Viral hepatitis	74 (32.4)	16 (28.1)	58 (33.9)
Non-alcoholic steatohepatitis	26 (11.4)	8 (14)	18 (10.5)
Cryptogenic	21 (9.2)	4 (7.0)	17 (9.9)
Others	45 (19.7)	16 (28.1)	29 (17)
MELD score	19 (14-24)	20 (13-25)	18 (12-23)	0.047
Biochemistry at ICU admission
Albumin (g/dL)	2.6 (2.3-2.9)	2.5 (2.3-1.7)	2.7 (2.3-2.9)	0.314
Creatinine (mg/dL)	0.9 (0.7-1.2)	0.9 (0.7-1.3)	0.8 (0.7-1.1)	0.009
Platelets (10³/mm³)	105 (67-142)	104 (74-143)	108 (82-157)	0.057
AST (U/L)	1055 (580-1829)	1370 (739-3174)	1003 (561-1434)	< 0.001
ALT (U/L)	611 (375-1041)	799 (435-1583)	488 (289-826)	< 0.001
INR	2.1 (1.7-2.7)	2.7 (1.9-3.7)	2.1 (1.7-2.7)	< 0.001
Bilirubin (mg/dL)	4 (2.3-6.2)	6.5 (4.1-8.8)	3.7 (2.5-5.3)	0.077
Surgical procedures
Donor hepatectomy time (min)	29 (23-40)	30 (23-39)		0.126
Cold ischemia time (min)	405 (329-492)	388 (311-495)	407 (334-483)	0.291
Warm ischemia time (min)	34 (30-37)	35 (30-39)	34 (3037)	0.079

Values are mean ± SD or median and interquartile range. Student's t test, Mann-Whitney U test or χ² test was used as appropriate. P value was considered significant at P < 0.05. AD: Early allograft dysfunction; BMI: Body mass index; MV: Mechanical ventilation; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; MELD: Model of end-stage liver disease; DRI: Donor Risk Index; ICU: Intensive care unit; INR: International normalized ratio.

Table 3 Correlation between donor hepatectomy time and postoperative liver function markers

Hepatectomy time	r	P value
Graft function markers
At admission
AST (IU/L)	-0.017	0.797
ALT (IU/L)	0.005	0.943
INR	0.033	0.617
Bilirubin (mg/dL)	0.069	0.287
At day 1
AST (IU/L)	-0.083	0.213
ALT (IU/L)	0.041	0.541
INR	-0.051	0.449
Bilirubin (mg/dL)	0.054	0.419
At day 7
AST (IU/L)	-0.026	0.717
ALT (IU/L)	0.068	0.336
INR	-0.055	0.443
Bilirubin (mg/dL)	0.087	0.234

Correlations between variables were calculated using Spearman’s test. P value was considered significant at P < 0.05. AST: Alanine transferase; ALT: Aspartate transferase; INR: International normalized radio.

Table 4 Effects of donor hepatectomy time below and above the median value (23 min) on liver transplantation outcomes

Outcomes	All patients (n = 243)	Patients with hepatectomy time < 23 min (n = 61)	Patients with hepatectomy time ≥ 23 min (n = 182)	P value
Early allograft dysfunction1	57 (25)	19 (33.9)	38 (22.1)	0.076
Need for retransplantation	13 (5.3)	4 (6.6)	9 (4.9)	0.628
Graft survival2	166 (81.8)	37 (75.5)	129 (83.8)	0.192
Patient survival	167 (68.7)	37 (60.7)	130 (71.4)	0.116
LOS, hospital (d)	10 (8-14)	10 (7-16)	10 (8-13)	0.790
LOS, ICU (d)	4 (3-6)	4 (3-6.5)	4 (3-5)	0.417

¹n = 228 (56; 172).

²n = 203 (49; 154).

LOS: Length of stay; ICU: Intensive care unit.