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Meta-Analysis
. 2008 Jun 25;3(6):e2468.
doi: 10.1371/journal.pone.0002468.

Consequences of cold-ischemia time on primary nonfunction and patient and graft survival in liver transplantation: a meta-analysis

James E Stahl  1 , Jennifer E Kreke, Fawaz Ali Abdul Malek, Andrew J Schaefer, Joseph Vacanti
Affiliations
Meta-Analysis

Consequences of cold-ischemia time on primary nonfunction and patient and graft survival in liver transplantation: a meta-analysis

James E Stahl et al. PLoS One. .

Abstract

Introduction: The ability to preserve organs prior to transplant is essential to the organ allocation process.

Objective: The purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant.

Methods: To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance.

Results: Twenty-six studies met criteria. Functionally, PNF% = -6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean-9.89535)2-0.0067663*(CIT Mean-9.89535)3, r2 = .625, , p<.0001. Mean patient survival: 93% (1 month), 88% (3 months), 83% (6 months) and 83% (12 months). Mean graft survival: 85.9% (1 month), 80.5% (3 months), 78.1% (6 months) and 76.8% (12 months). Maximum patient and graft survival occurred with CITs between 7.5-12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches.

Conclusion: The results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Article selection flowchart.
Figure 2
Figure 2. Weighted PNF (%) vs. mean CIT for each study subgroup.
PNF% = −6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean−9.89535)formula image2−0.0067663*(CIT Mean−9.89535)formula image3. r2 = .625. p = <.0001.
Figure 3
Figure 3. Patient survival stratified by CIT interval.
Cold-ischemia time (CIT) intervals: cit 1 (<5 hrs), cit 2 (5–7.5 hrs), cit 3 (7.5–10 hrs), cit 4 (10–12.5 hrs), and cit 5 (>12.5 hrs.). Time units = months.
Figure 4
Figure 4. Patient Survival at 1, 3, 6 and 12 months versus mean CIT.
Figure 5
Figure 5. Graft survival stratified by CIT interval.
Cold-ischemia time (CIT) intervals: cit 1 (<5 hrs), cit 2 (5–7.5 hrs), cit 3 (7.5–10 hrs), cit 4 (10–12.5 hrs), and cit 5 (>12.5 hrs.).
Figure 6
Figure 6. Graft Survival at 1, 3, 6 and 12 months versus mean CIT.
See this image and copyright information in PMC

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