Donor Risk Index could be a Predictor of “Resistant to Flow” Liver Grafts

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Abstract

Introduction

The Donor Risk Index (DRI) was validated with the aim of being a predictive model of graft survival based on donor characteristics. The measurement of intraoperative arterial hepatic flow and clearance of indocyanine green (PDR-ICG) are variables in the intraoperative time that reflects graft perfusion and they could be influenced by the quality of the grafts.

Aim

To analyze the influence of DRI on intraoperative liver hemodynamic alterations and on intraoperative dynamic liver function tests (PDR-ICG).

Materials and Methods

We propose an observational study of a single center cohort (n = 228). The measurement of the intraoperative flows is made with a flow meter VeriQ). ICG-PDR was obtained from all patients with a LiMON monitor (Pulsion Medical Systems AG, Munich, Germany). DRI was calculated by the previously validated formula. Unless otherwise stated, data were expressed as mean (SD, standard deviation) or n (%). When data were normally distributed (based on the Kolmogorov-Smirnov test) they were compared using the t-Student test. The qualitative variables and risk measurement was analyzed using the chi-square test. Kaplan Meir curves were used to show survival analysis.

Results

DRI mean value ??was 1.58 ± 0.31. DRI> 1.7 group was considered grafts of poor quality had an intraoperative arterial flow 234.2 ± 121.35 ml / min compared with DRI <1.70 group with an intraoperative arterial flow of 287, 24 ± 156.84, p = 0.02. DRI > 1,7 grafts showed a increase risk to test a low arterial flow less than 180 ml/min. (OR: 1,89 95% confidence interval [95% CI], 1,35-3,35).p<0.04). DRI> 1.70 group had a 60min ICG-PDR of 14.75 ± 6.52% / min compared with DRI <1.70 group with a 60min ICG-PDR of 16.68 ± 6.47% / min, p = 0.09. DRI > 1,7 grafts showed a increase risk to test a low ICG-PDR 60 min less than 10 ml/min. (OR: 2,15 95% confidence interval [95% CI], ( 1,07-4,31), p= 0,03.

Conclusion

DRI considers variables such as elderly donors and prolonged cold ischemia time. Poor quality grafts have a greater susceptibility to ischemia reperfusion damage. A decrases in the measure of intraoperative hepatic artery flow and ICG-PDR could be translating an increase of intrahepatic resistance. To identify grafts “Resistant to Flow” previous to transplant them in new machine perfusion devise could be the aim of posterior studies.

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