%0 Journal Article
%T Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis
%A James E. Stahl
%A Jennifer E. Kreke
%A Fawaz Ali Abdul Malek
%A Andrew J. Schaefer
%A Joseph Vacanti
%J PLOS ONE
%D 2008
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0002468
%X 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¨C12.5 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.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002468