Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation

Donor and recipient factors are closely associated with graft survival after orthotopic liver transplantation (OLT). This study was performed to analyze clinical characteristics of recipients and donors, which affect 30-day graft loss after OLT. MATERIALS AND METHODS: One hundred eighty-six livers from heart-beating donors were accepted between May 1997 and June 1998 at the University of Pittsburgh Medical Center. Donor variables that were analyzed included age, sex, cold ischemia time (CIT), warm ischemia time (WIT), imported versus local procurement, cardiopulmonary arrest, serum sodium level, and dopamine dose. The recipient characteristics included native liver disease and UNOS status. Two-sided Fisher exact test and stepwise logistic regression were used for univariate and multivariate analyses. P-values < .05 were considered statistically significant. RESULTS: Twenty-eight grafts (15.1%) were lost within 30 days of OLT. The following factors were found to adversely affect graft survival: donor sodium > 155 mEq/L (P = .002); CIT > 12 hours (P = .002); WIT > 45 minutes (P = .002); and imported liver graft (P = .048). Logistic regression revealed that donor sodium (odds ratio, 3.03; 95% CI, 1.05 to 8.74), CIT (OR 1.20; 95% CI 1.05 to 1.38), WIT (OR 1.06; 95% CI 1.01 to 1.09) were independent predictors of early graft loss. CONCLUSION: Donor hypernatremia as well as warm and cold ischemia times independently affect graft outcomes in the early postoperative period after OLT. Avoidance of long preservation and correction of donor sodium level are recommended to optimize results and survival in OLT.     

热缺血损伤对大鼠移植肝组织能量代谢及存活期的影响

目的：探讨不同热缺血时间下大鼠肝组织能量代谢变化规律,预测供肝耐受热缺血的安全时限。方法：实验动物按供肝热缺血时间分别为0、10、15、20、30、45和60min,随机分为7组。采用反相高效液相色谱法测定单纯热缺血后肝组织能量代谢指标并进行超微结构的观察。然后按各组条件分别作原位肝移植,观察移植后24、48h各组肝组织能量代谢指标的恢复性变化,并统计生存时间。结果：供肝经受热缺血损伤后,肝组织ATP含量和EC水平远逐渐下降,其中前30min下降比较急剧,以后趋向平缓。热缺血30min内肝组织ATP含量和EC水平在肝移植再复流24h后基本得到恢复,术后大鼠仍可以获长期存活。45min组,移植肝在48h后能量代谢的功能也基本恢复,虽不足以影响术后的1周存活率,但对大鼠肝移植术后的3个月存活率影响显著。60min组,肝脏能量代谢储备功能难以恢复,大鼠术后生存天数显著降低。结论：供肝组织三磷酸腺苷（ATP）含量和能荷（EC）水平以及其移植术后恢复的潜能是衡量供肝质量的重要标准。供肝热缺血损伤的时间与肝组织能量代谢功能的恢复及术后动物生存情况密切相关。     

Influence of ischemia and surgery times on development of primary dysfunction liver transplant in patients

OBJECTIVE: (1) To determine the incidences of primary failure and primary dysfunction of liver transplants performed at our center. (2) To evaluate the effects of mean cold and warm ischemia times as well as the length of five stages of surgery on the development of primary dysfunction. PATIENTS AND METHODS: We reviewed 248 liver transplants consecutively performed in 206 patients at the Hospital Ramón y Cajal, Madrid over 79 months. Six cases were excluded because the patients died within 24 hours of transplant, it was therefore not possible to establish the postoperative liver function. Recipients were classified according to their posttransplant liver function as showing normal primary function (NP) or primary dysfunction (PD), which included patients with primary failure (PF) and inadequate primary function (IPF). The NP and IPF groups were defined in terms of transaminase levels and prothrombin activity from posttransplant days 2 to 7. The following factors were analyzed: graft cold (CIT) and warm (WIT) ischemia times; graft arterial (AIT) and venous (VIT) ischemia times; and times of surgery (ST), arterial anastomosis (AAT), and anhepatic phase (APT). RESULTS: Twenty-three (9.3%) patients were classified as showing PD, 12 (4.8%) of whom suffered an episode of PF. The mean values (and standard deviations) of the times (in minutes) were ST = 308.19 +/- 109.78; CIT = 411.08 +/- 140.62; WIT = 46.51 +/- 37.70; AIT = 510.95 +/- 165.95; VIT = 458.68 +/- 151.98; AAT = 54.12 +/- 31.84; and APT = 58.53 +/- 90.07. No significant differences were detected in the mean times of patients showing NP or PD. Neither were any differences observed between the two patient groups according to the variables CIT longer than 10 hours and WIT longer than 60 minutes. CONCLUSIONS: Our times of surgery and cold ischemia are shorter than those reported by other transplant teams, mostly North American surgeons who quote figures of around 7 and 12 hours, respectively. These relatively low values may account for the lack of effect shown by the times of ischemia or surgery stages on the appearance of primary dysfunction in patients undergoing liver transplant.     

Impact of warm ischemia time on outcomes for kidneys donated after cardiac death Post-KAS

Prolonged warm (WIT) and cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post-transplant outcomes in the post-KAS era is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death-censored graft failure for DCD kidneys. The 2018 SRTR SAF was utilized to identify post-KAS DCD kidney transplants occurring from 2015 to 2018. Relative risk and Cox regression were used to calculate risk of delayed graft function and hazard of death-censored graft failure, respectively. We identified 4,680 kidneys from DCD donors transplanted from 2015 to 2018 with recorded WIT and CIT times. Median WIT was 21.0 minutes (IQR 14.0-28.0), and CIT was 18.5 hours (IQR 13.9-23.5). The overall incidence of DGF was 42.7%. In a univariable relative risk regression model, extended CIT (24-30 hours:RR 1.37, 95% CI 1.15-1.77; >30 hours:RR 1.47, 95% CI 1.22-1.77) and WIT (20-40 minutes:RR 1.10, 95% CI 1.03-1.17) were associated with increased risk of DGF. When included in a multivariable model, neither prolonged CIT nor WIT were significantly associated with death-censored graft failure. Prolonged WIT and CIT are associated with increased DGF but not death-censored graft failure in recipients of DCD kidney transplants in the post-KAS era. Extended ischemia alone should not be used as a basis for discard or non-utilization of these organs.     

大鼠无心跳供体热缺血损伤后供肝组织学与超微结构的动态变化

目的动态观察移植肝热缺血损伤后组织学与超微结构的变化特点，预测无心跳供体（NHBD）中供肝耐受热缺血的安全时限。方法实验动物按供肝热缺血时间分别为0、10、15、20、30、45、60min，随机分为7组。按各组条件分别作原位肝移植，动态观察单纯热缺血期和肝移植术后6h、24h、48h各组移植肝组织学、组织化学和超微结构变化规律。结果NHBD的供肝不仅发生热缺血阶段缺血缺氧造成的损伤，在移植肝复流后，也存在再灌注损伤，且再灌注期肝组织损伤的程度与热缺血时间长短有密切关系。热缺血30min以前，移植肝仅出现组织细胞的变性，未见明显坏死。45min组，肝组织可见小灶状的坏死，在小叶中央区首先发生。60min组，肝细胞坏死的范围扩大，呈片状或弥漫性分布；肝窦内皮细胞明显肿胀呈泡状或气球状，肝血窦阻塞，呈微循环障碍。结论大鼠供肝经受30min以内热缺血损伤，肝组织损伤处在可复性阶段。热缺血60min以后，呈现不可逆性的形态学改变。     

Evaluating the effects of extended cold ischemia on interstitial metabolite in grafts in kidney transplantation using microdialysis

Purpose

During kidney transplantation (KTx), the length of cold ischemia time (CIT) and the subsequent changes in energy metabolism may lead to variations in interstitial metabolites. Using microdialysis (MD), we evaluated the effects of a short and long CIT on changes of these metabolites.

Methods

Sixteen pigs were randomized in two identical groups, one with a short CIT and the other one with a long CIT. Using MD in the transplanted grafts, we evaluated the parenchyma concentrations of glucose, lactate, pyruvate, glutamate and glycerol in different stages.

Results

We noted that during the warm ischemia time (WIT) and in the early post-reperfusion phase glucose levels increased more significantly in the long CIT group and remained high until the end of monitoring. At the end of CIT and during WIT, the long CIT group had a significantly higher glycerol level, but the level dropped gradually in the late post-reperfusion phase and reached a steady state in both groups.

Conclusions

The extended CIT clearly results in considerably impaired graft metabolism. The high interstitial glucose levels within hours after KTx could be considered as a marker of primary delayed function of the graft. Furthermore, the glycerol value could reflect the extent of graft injury during the ischemia time or in case of acute impairment of graft perfusion.     

The tolerance time limits of biliary tracts of liver grafts subjected to warm ischemia and cold preservation: an experimental study in swine

Objective

The objective of this study was to investigate the tolerance time limits of liver grafts and biliary tracts with warm ischemia to cold preservation providing experimental data to the prevent primary graft nonfunction and biliary necrosis after orthotopic liver transplantation (OLT).

Methods

OLTs were performed in Bama miniature swine. Morphological and functional changes in the liver graft and biliary tracts were investigated after 10 minutes of warm ischemia and various durations of cold preservation.

Results

When grafts were subjected to 10 minutes of warm ischemia followed by less than 16 hours of cold preservation, all animals survived 1 week; no animal died of biliary necrosis. However, when the cold preservation time exceeded 16 hours, the incidence of biliary necrosis increased significantly (P < .05) with deaths due to bile leaks. As cold preservation persisted, primary graft nonfunction and intraoperative or early postoperative deaths occurred, and all surviving animals developed biliary necrosis. When compared with the group undergoing less than 16 hours of cold preservation, the morphological scores and apoptosis index of epithelial cells of graft bile ducts were significantly increased among the group subjected to more than 16 hours of cold preservation after reperfusion (P < .05), whereas the activity of Na+-K+-ATPase and Ca2+-ATPase of graft bile ducts were reduced significantly (P < .05). Liver function tests showed the concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase, and alkaline phosphatase (ALP) decreased more slowly among the group undergoing more than 16 hours of cold preservation after operation.

Conclusions

We concluded that given 10 minutes of warm ischemia, cold preservation should be less than 16 hours to avoid early biliary necrosis; the corresponding tolerance time limit of the liver to cold preservation was less than 20 hours.     

不同冷保存时间的热缺血供肝在肝移植中的疗效

目的 探讨不同冷保存时间的热缺血供肝在肝移植中的疗效.方法 回顾性分析2006年1月至2007年12月中山大学附属第一医院收治的154例肝移植受者采用热缺血时间≤10 min的无心跳供者肝脏进行肝移植的疗效.根据冷保存时间将患者分为3组:<8 h为Ⅰ组,58例;8～12 h为Ⅱ组,62例;>12 h为Ⅲ组,34例.采用方差分析、t检验和X~2检验分析3组肝移植术后ALT峰值、并发症、移植肝存活和受者生存情况的差异.结果 3组受者术后均未发生原发性移植肝无功能.随访时间8～32个月,Ⅰ组受者的ALT峰值、感染发生率、胆道并发症发生率、移植肝存活率和生存率分别为(482±357)U/L、12%(7/58)、12%(7/58)、86%(50/58)和88%(51/58),Ⅲ组受者分别为(1274±608)U/L、29%(10/34)、26%(9/34)、68%(23/34)和71%(24/34),两组比较差异有统计学意义(t=5.X~2=4.28,6.77,4.51,4.28,P<0.05);而Ⅱ组受者仅ALT峰值达到(953±424)U/L,与Ⅰ组比较差异有统计学意义(t=4.76,P<0.05).结论 热缺血时间≤10 min的供肝能够耐受12 h的冷保存损伤,超过此时限,移植术后胆道并发症和感染的发生率显著升高,移植肝存活率和受者生存率显著降低.     

The influence of warm and cold ischemic time on the outcome of cadaveric renal transplantation

The influence of warm and cold ischemic time (WIT and CIT) on renal allograft function and allograft survival rates was analyzed from the Eurotransplant data. From 1977 through 1980 renal allograft recipients were divided into three groups, according to the length of the WIT of their graft: group I, 0-10 min (n = 2,636); group II, 11-20 min (n = 108); group III, 21-35 min (n = 17). Differences in graft function or graft survival have not been observed between these groups. It is concluded that donor kidneys with a WIT up to 20 min are acceptable for transplantation. The transplantation results in group III suggest that 35 min is a safe limit for acceptance, but the small number of transplantations in this group does not justify a firm conclusion. A combined analysis of warm and cold ischemia shows that simple cold storage up to 50 h is safe and acceptable, provided that warm ischemia is kept minimal (less than 10 min). It seems advisable to keep hypothermic preservation within the limit of 30 h, when WIT exceeds 10 min.     

The marginal donor: a single-center experience in orthotopic liver transplantation

The use of marginal donors has become more common worldwide due to the sharp increase in recipients with a consequent shortage of suitable organs. The definition of "marginal donor" has not been reached by all centers. We herein analyzed our single-center experience over the last 3 years in liver transplantation (OLT) to evaluate the outcomes of using a high percentage of so-called "marginal donors", according to the current classification from the National (Italian) Center of Transplantation (CNT). Among the 78 OLT performed in 77 patients from January 1, 2003 to October 31, 2005, donor livers were divided into three groups according to the CNT classification. We evaluated donor variables, cold ischemia time (CIT), warm ischemia time (WIT), MELD score, and length of hospital stay. Histologic graft steatosis was correlated with estimated steatosis by ultrasound. There were no differences among the three graft recipient groups concerning CIT, WIT, MELD score, and the length of hospital stay. Steatosis is indicated in all series as a definite variable for a higher risk of postoperative mortality. CIT is necessarily related to donor retrieval policy and organization. Donor age seemed also to be related to a possible increase in postoperative mortality, but there are significant variations in the definition of the age limit. We failed to observe a correlation between a higher mortality rate and any of the variables currently listed to define a "marginal donor." A shorter CIT seemed to positively influence the role played by the other variables identifying a "marginal liver." Finally, the use of HCV(+) or HBV(+) grafts did not lead to an increased mortality.     

不同热缺血时间的无心跳供肝在肝移植中应用的疗效评价

目的:探讨不同热缺血时间的无心跳供肝在临床肝移植中应用的疗效。方法:回顾性分析142例冷保存时间在12h之内的不同热缺血时间的无心跳供肝肝移植患者的临床资料, 根据热缺血时间分为3组：Ⅰ组为5 min之内, 43例; Ⅱ组为5～10 min, 77例; Ⅲ组为10～15 min, 22例。比较3组间肝移植术后谷丙转氨酶（ALT）峰值、原发性移植肝无功能、急性排斥反应、胆道并发症、血管并发症、感染以及移植肝存活和受体存活的差异。结果:3组患者术后均未发生原发性移植肝无功能。Ⅱ组术后ALT峰值及感染发生率显著高于Ⅰ组; 而Ⅲ组术后ALT峰值、胆道并发症发生率、血管并发症发生率及感染发生率均显著升高。随访 8~32个月。Ⅲ组移植肝存活率及受体存活率均降低, 与Ⅰ组和Ⅱ组比较, 差异均有统计学意义。结论:冷保存时间在12 h之内的无心跳供肝能耐受热缺血的安全时限为10 min; 热缺血时间大于10 min的供肝, 移植术后相关并发症发生率显著增加, 移植肝和受体存活率显著降低。     

Effect of warm ischemia on graft outcome in laparoscopic donor nephrectomy

PURPOSE: To assess the impact of warm ischemia time (WIT) on delayed graft function (DGF), graft loss, and graft function in laparoscopic donor nephrectomy (LDN). PATIENTS AND METHODS: We prospectively studied 100 kidney recipients from LDN donors from 2001 to 2003. For comparison of graft outcome with different extents of WIT, recipients were divided into three groups: group A received kidneys having 4 to 6 minutes, group B kidneys having >6 to 10 minutes, and group C kidneys having >10 minutes of WIT. The median follow-up was 415 days (range 11-791) days. RESULTS: The mean kidney WIT was 8.7 minutes (range 4-17 minutes). Graft outcome (DGF, graft loss, and median serum creatinine) was not significantly different in the three groups. CONCLUSIONS: Different extents of WIT in LDN, within the range of our study, were not associated with an adverse outcome in kidney transplantation.     

Influence of cold ischemia time on complement activation, neopterin, and cytokine release in liver transplantation

OBJECTIVES: The aim of this study was to determine whether a cold ischemia time (CIT) of >12 hours influences the activation of complement as well as the plasma concentrations of neopterin, interleukin (IL)-6, or IL-8 in orthotopic liver transplantation (OLT). PATIENTS AND METHODS: Eighteen consecutive patients undergoing OLT using a veno-venous bypass technique were divided into 2 groups: duration of CIT >12 hours (group 1; n = 11), and CIT <12 hours (group 2; n = 7). Blood samples were drawn preoperatively, 1 minute before, and 120 minutes after reperfusion. RESULTS: Preoperatively, complement split products, neopterin, IL-6, and IL-8 levels did not differ between the groups. At 120 minutes after reperfusion, the concentrations of C3a, SC5b-9, neopterin, IL-6, and IL-8 were significantly increased in both groups compared with the preoperative values or the levels determined 1 minute before reperfusion (P < .05). Patients in group 1 showed significantly higher IL-8 levels at 120 minutes after reperfusion (P < .05). CONCLUSION: Complement is activated and pro-inflammatory cytokines released after reperfusion in OLT using a veno-venous bypass technique, but only IL-8 plasma levels were influenced by the duration of CIT. Therefore, alterations following prolonged CIT seem to not be complement-mediated.     

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??Objective??To establish the clinic risk factors resulting in initial poor graft function (IPGF) after orthotopic liver transplantation (OLT). Methods??Eighty cases of orthotopic liver transplantation admitted between June 2002 and December 2004 in Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively.The group of IPGF was confirmed if alanineaminotransferase (ALT) and/or aspartate aminotransferase (AST) was above 1500 IU/L within 72 hours after OLT while non IPGF group below 1500 IU/L.Recipient associated factors before OLT analyzed were age,sex,primary liver diseases and Child??Pugh’s classification.Factors analyzed with peri??operative period were non??heart bearting time (NHBT),cold preservation time (CIT),warm ischemic time (RWIT),liver biopsy at the end of cold ischemia and ALT and/or AST within 72 hours after OLT.Logistic regression model was applied to filter the possible factors resulting in IPGF. Results??Donor NHBT,CIT and RWIT were longer significantly in IPGF group than non IPGF group (P<0.05).In logistic regression model,NHBT was the risk factor leading to IPGF (P<0.05) while CIT,RWIT were the possible risk factors.In one case of IPGF group PGNF was appeared with moderate hepatic steatosis. Conclusion??NHBT is an important risk factor leading to IPGF while steatosis in donor liver. CIT and RWIT are potential risk factors.     

不同热缺血时间对大鼠移植肝功能状态及存活期的影响

目的：探讨不同热缺血时间条件下，大鼠原位肝移植术后肝脏功能和组织形态变化规律，并对动物远期存活情况进行观察，预测无心跳供体（NHBD）中供肝耐受热缺血的安全时限。方法：实验动物按供肝热缺血时间分别为0、10、15、20、30、45、60min，随机分为7组。然后按各组条件分别作原位肝移植，观察肝移植后24、48h、3和5d各组肝脏功能和组织形态的恢复性变化，并统计生存时间。结果：供肝经受30min以内热缺血损伤，各组移植术后生存天数差异无显著性，热缺血30min组，肝移植术后1周的存活率达到83.3％（10/12），1个月和3个月存活率分别为58.3％（7/12）和50.0％（6/12）。热缺血45min组，术后1周的存活率为66.7％（8/12），但1个月和3个月存活率分别为33.3％（4/12）和8.3％（1/12）。至于热缺血60min组，1周的存活率仅为8.3％（1/12）。结论：大鼠的供肝可以安全地耐受30min以内的热缺血。45min的热缺血损伤，虽对术后1周存活率无明显影响，但大鼠肝移植术后的远期存活时间明显缩短。60min以后，移植肝组织的结构和功能均难以恢复，大鼠术后生存天数显著降低。     

Deleterious influence of prolonged warm ischemia in living donor kidney transplantation

Background

Recent studies investigating early graft function (EGF) after living donor kidney transplantation (LDKT) identified prolonged warm ischemia time (WIT) as a risk factor for the occurrence of poor EGF. The latter is associated with long-term graft loss; therefore the question arises whether prolonged WIT affects long-term outcomes in LDKT.

Methods

Data were collected on 472 consecutive adult LDKTs. Patients were divided according to the total WIT into 3 groups with short (<30 minutes), intermediate (30-45 minutes), or prolonged (>45 minutes) WIT.

Results

Of all patients, 193 (40.9%) experienced short, 249 (52.8%) intermediate, and 30 (6.4%) prolonged WIT. Prolonged WIT was a significant risk factor for the occurrence of poor EGF with an adjusted odds ratio of 4.252 (95% confidence interval [CI), 1.914 −9.447). Long-term graft survival was impaired in patients with prolonged WIT, with an adjusted hazard ratio of 3.163 (95% CI, 1.202-8.321). Multivariate analysis revealed determinants of prolonged WIT, including laparoscopic procurement, recipient overweight, right donor kidney, and multiple renal arteries.

Conclusion

Prolonged WIT impairs long-term graft survival in LDKT. This finding underlines the need to develop strategies to avoid the occurrence of prolonged WIT in LDKT.     

Recipient and perioperative risk factors associated with liver transplant graft outcomes

Background

Orthotopic Liver transplantation (OLT) is currently considered to be the ultimate form of therapy for most patients with end-stage liver diseases. The identification of recipient and various perioperative factors that may affect the graft outcomes is critical. This study sought to analyze the preoperative and perioperative factors associated with graft outcomes in our institute.

Methods

This retrospective study of liver transplanted patients from January 2002 to December 2009 determined the incidence of 2 forms of primary dysfunction (PDF): Primary nonfunction (PNF) and initial poor function (IPF).

Results

The 97 posttransplant patients included in the study had an average age of 52.74 years. The majority of indications for OLT were hepatitis B and/or C cirrhosis, alcoholic cirrhosis, and hepatocellular carcinoma. The incidence of PDF was 31.9% (31/97) with 7.2% (7/97) PNF and 24.7% (24/97) IPF. Additionally, we observed 68.1% (66/97) to display immediate function (IF). Warm ischemic time (WIT) and operative time were significantly longer in the PDF compared with the IF group. The logistic regression model showed a WIT of >45 minutes to be a risk factor leading to PDF (odds ratio, 11.74; P < .05). An operative time of >6 hours and operative blood loss of >2 L were possible risk factors.

Conclusion

Prolonged WIT (>45 minutes) was the only significant risk factor among other established parameters for graft function. Nevertheless, reduced operative times and blood loss may improve the outcomes of OLT.     

无心跳供体中供肝微循环的动态变化

目的 探讨不同热缺血时间下大鼠无心跳供体肝组织微循环的变化规律，预测供肝耐受热缺血的安全时限。方法 实验动物按供肝热缺血时间分别为0、15、30、45、60min，随机分为5组。然后按各组条件分别作原位肝移植．对肝移植术后各组血清透明质酸(HA)的水平进行动态检测，以及观察肝组织微循环超微结构的动态变化。结果 在热缺血30min以内，移植肝组织复流后能逐渐恢复至正常的微循环结构和功能。热缺血45min，复流后大部分肝血窦腔可逐渐恢复通畅。但部分血窦仍充满较多的膜浆泡和血细胞积滞；热缺血45min以前各组术后3d血清HA可基本恢复。热缺血60min，复流后内皮细胞损伤不但不能恢复，且出现加重、扩大趋势。结论 供肝经受30min以内热缺血损伤，肝组织微循环的变化处在可复性阶段。45min的热缺血时间可能县供肝微循环功能耐受热缺血损伤的极限．热缺血60min以后．呈现不可逆性的微循环障碍．     

Liver transplantation using non-heart-beating donors: Belgian experience

Mortality on liver transplantation (OLT) waiting lists has increased dramatically. Until recently, non-heart-beating donors (NHBD) were not considered suitable for OLT, because of a higher risk of primary graft nonfunction (PNF) and biliary strictures. However, recent experimental/clinical evidence has indicated that NHBD-OLT is feasible when the period of warm ischemia is short. PURPOSE: To characterize the results of NHBD-OLT in Belgium, a survey was sent to all Belgian OLT centers. RESULTS: Between January 2003 and November 2005, 16 livers originating from NHBD were procured and transplanted. The mean donor age was 48.8 years, including 9 males and 7 females with mean time of stop-therapy to cardiac arrest being 18 minutes and from cardiac arrest to liver cold perfusion, 10.5 minutes. Mean recipient age was 52.2 years including 12 males and 4 females. Mean cold ischemia time was 7 hours 15 minutes. No PNF requiring re-OLT was observed. Mean post-OLT peak transaminase was 2209 IU/L, which was higher among imported versus locally procured grafts. Biliary complications occurred in 6 patients requiring re-OLT (n = 2), endoscopic treatment (n = 2), surgical treatment (n = 1), or left untreated (n = 1). These tended to be more frequent after prolonged warm ischemia. Graft and patient survivals were 62.5% and 81.3%, respectively, with a follow-up of 3 to 36 months. CONCLUSION: This survey showed acceptable graft/patient survivals after NHBD-LT. The NHBD-liver grafts suffered a high rate of ischemic injury and biliary complications and therefore should be used carefully, namely with no additional donor risk factors, lower risk recipients, and short cold/warm ischemia.