Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Introduction: The ability to preserve organs prior to transplant is essential to the organ allocation process.\ud 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.\ud Methods: To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature\ud identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted\ud 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.\ud Results: Twenty-six studies met criteria. Functionally, PNF% =26.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean29.89535)^220.0067663*(CIT Mean29.89535)^3, r2 = .625, , p,.0001. Mean patient survival: 93 % (1 month), 88 %\ud (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.\ud Conclusion: The results of this work imply that CIT may be the most important pre-transplant information needed in the\ud decision to accept an organ