Influence of cold ischemia time and graft transport distance on postoperative outcome in human liver transplantation

Purpose. The association between hepatic allograft cold ischemia time (CIT) and graft transport distance (GTD) in human liver transplantation was examined by investigating whether extended graft transportation prolongs the CIT and adversely affects graft survival. Methods. We retrospectively analyzed 186 consecutive orthotopic liver transplants (OLTs) done between May 1997 and July 1998. The number of miles from the donor hospital to the University of Pittsburgh Medical Center in a straight line was measured in each case, and defined as the GTD. The OLTs were divided into two groups according to whether the GTD was ≤200 miles or >200 miles. The latter group was then subdivided into groups of GTD 200-400 miles, GTD 400-600 miles, and GTD >600 miles. The CIT and graft outcome within 90 days after OLT were assessed. Results. Extended GTD prolonged the CIT (P < 0.001). The rate of hepatic allograft loss in the long GTD group was significantly higher than that in the short GTD group (P = 0.018). When the OLTs were subdivided according to GTD, the CIT increased and graft survival decreased as the GTD extended. Hepatic allograft transportation for a long distance prolonged the CIT and decreased the graft survival rate. Conclusion. Since prolonged CIT is a major risk factor, avoiding long-distance graft transportation is recommended when the donor risk factors are high.