Impact of Ischemia and Preservation Times on Survival in Transplant Recipients From After Circulatory Death Donors.

BACKGROUND: The limitation of ischemia times, which damages the organs and impacts transplant outcomes, is a drawback of controlled donation after circulatory death. METHODS: The aim of the study was to analyze the influence of preservation and ischemia times on overall survival and both censured graft survival and overall graft survival. This was an observational and retrospective study of patients undergoing liver transplantation with grafts from controlled donation after circulatory death between November 2013 and November 2022. RESULTS: Sixty-five patients were included in the study. Twenty percent (12 patients) developed early graft dysfunction according to Olthoff's classification, and 7 patients (11.6%) scored ≥7 points according to the Model for Early Allograft Function Scoring scale. Five patients (7.6%) met the criteria for primary graft failure. The retransplantation rate was 9.2% (6 cases). Fifty patients (76.9%) remained alive, and 15 patients (23.1%) died. When analyzing overall survival based on the main preservation and ischemia times, we observed that the best results occurred in the group with a functional warm ischemia time <12 minutes, with a survival rate at 1, 3, and 5 years of 95.8%, 87.1%, and 87.1%, respectively (P = .043). Regarding the analysis of censured graft survival based on the main preservation and ischemia times, we found that the worst results occurred in the group with a cold ischemia time ≥6 hours, with a survival rate of around 48% at 3 and 5 years (P = .047). CONCLUSIONS: High-risk patients have lower overall and graft survival in the short and long term in grafts from controlled donation after circulatory death.

Reassessment After Locoregional Treatment of Hepatocellular Carcinoma Previous Liver Transplantation: Is MRI Necessary for All Patients?

BACKGROUND: The tumor response of cirrhotic patients with hepatocellular carcinoma (HCC) undergoing locoregional treatment (TLR) before liver transplantation can be evaluated using different imaging tests. The aim of this study was to compare the correlation of radiological response evaluated by magnetic resonance imaging (MRI) vs computed tomography (CT) vs ultrasound with histopathological findings. METHODS: A retrospective single-center study was performed. Data of patients undergoing Liver transplantation due to HCC between January 2010 and December were collected, selecting patients who underwent TLR. RESULTS: Four hundred and four patients were transplanted, of whom 103 (25.5%) had HCC. Ninety-seven patients (93.2%) received TLR. Eighty-eight of these patients (90.7%) underwent a reevaluation imaging test: 8 (8.2%) underwent ultrasound, 68 (70.1%) underwent MRI, and 12 (12.4%) underwent CT. Of the 88 patients, 59% were classified as nonviable LR-TR (Liver Imaging Reporting and Data System Treatment Response), 32.5% as viable LR-TR, and the rest (8.5%) as equivocal LR-TR. Regarding the correlation of the degree of radiological response according to each imaging test, ultrasound categorized 62.5% as nonviable LR-TR vs 60.6% by MRI vs 44.4% by CT, with these differences not being significant (P = .779). Regarding the correlation of patients classified as nonviable LR-TR by each test and total tumor necrosis in histopathology, both MRI and ultrasound correctly classified 60% of complete necrosis as nonviable LR-TR, and in the case of CT, it was 50%, with these differences not being significant (P = 1). CONCLUSION: Ultrasound and CT have obtained similar results as reevaluation tests to MRI, which could replace it in case of unavailability of the latter.