Celsior

The initial objective of this study is to analyze the impact on survival of the preservation solution used. Secondarily, the influence of donor age, underlying pathology, and graft ischemia time is investigated.

A multicenter retrospective analytical observational study has been carried out. A population of 1822 liver transplant recipients is studied in 4 Andalusian hospitals between 1995 and 2014. Survival of the patient and graft is analyzed by groups based on the conservation solution used, the age of the donor, the pathology indicated for transplant and the ischemia time, and the relationship between the variables through a bivariate study. A descriptive and predictive multivariate analysis of the variables was performed.

Comparison of the graft and patient survival functions for each preservation solution did not differ significantly. The bivariate analysis shows a significantly higher utilization of Celsior and histidine-tryptophan-ketoglutarate solution in graft loss. The comparison between donor age groups showed significant differences in favor of donor grafts younger than 50 years. In the multivariate analysis of patient and graft survival, the donor age obtained a hazard ratio of 1.008 (P < .005) with donors older than 47.6 and 47.5 years, respectively.

Survival analysis between pathology groups found significant differences, not obtaining predictive power for patient or graft survival in the multivariate study. No significant differences were found in survival according to ischemia time, but there was a relationship between early graft loss and longer mean cold ischemia times up to 18 hours.

In this article, the authors compare NAC infusion during liver procurement with standard portal and aortic flush. A clear allocation paradigm and NAC infusionscheme are described, using dosing and administrationrationale and protocols based on previously published work,5 with the added modihcation of 300mg NAC to initial Celsior flush (Genzyme Corporation, Cambridge, MA).The authors select EAD as their primary endpoint based on the 2013 study by D′Amico et al,5 which notes statistically signihcant differences in liver allograft survival after NAC administration, as well as lower rates of primary dysfunction. In this work, however, no statistically signihcant difference was detected in EAD between groups, even when accounting for different EAD scoring paradigms.Interestingly, supplemental subgroup anal. of livers with prolonged cold ischemia >6 h, which has known association with increased organ injury and post operative complications,6 demonstrates blunting of postoperative transaminase rise, favoring NAC.This suggests a protective effect when a greater degree of ischemic injury is present and mimics prior hndings by D′Amico et al, who reported graft primary dysfunction was lower after NAC treatment in organs with higher baseline donor risk indexes.5 Gomez-Gavara et al also report a trend toward a signihcant decrease in EAD among subjectively steatotic livers treated with NAC. Although intriguing, the results are limited by the small number of patients in these subgroups. Of note is that signihcantly fewer patients in the present study experienced early graft loss requiring transplantation in the NAC group, and no cases of graft loss due to EAD occurred in the NAC treatment group.Although the authors discount the signihcance of this finding due to hepatic artery thrombosis accounting for graft loss in 4 of 7 cases (n = l NAC and n = 3 control), risk of hepatic artery thrombosis is increased in patients with severe ischemia-reperfusion injury due to an increase in intrathepatic resistance to vascular how.7 Further study, especially in extended criteria donors, including a more granular anal. of tissue injury, biomarkers, and clin. outcomes, is necessary to hush out the effect of NAC in grafts at high risk for preservation and reperfusion injury.