Effect modification in liver allografts with prolonged cold ischemic time

D. L. Segev, L. M. Kucirka, G. C. Nguyen, A. M. Cameron, J. E. Locke, C. E. Simpkins, P. J. Thuluvath, R. A. Montgomery, W. R. Maley

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Although prolonged cold ischemia time (PCIT) is generally associated with worse outcomes following liver transplantation, evidence suggests that some recipients and some donors might be more sensitive to PCIT than others. The purpose of this study was to identify factors that predict a higher risk of graft loss after a transplant with PCIT when compared with a similar transplant with average CIT (ACIT). 14 637 recipients reported to United Network for Organ Sharing (UNOS) in the model for end-stage liver disease (MELD) era were studied by interaction term analysis in proportional hazards models. Recipient diabetes, obesity and donor African American (AA) ethnicity were found to significantly amplify the adverse effects of PCIT. Graft loss was 1.85-fold higher in diabetic or obese PCIT recipients compared with diabetic or obese ACIT recipients, (vs. 1.17 for the same comparison in non-diabetic non-obese recipients). Similarly, graft loss was 1.80-fold higher in AA PCIT donors compared with AA ACIT donors, (vs. 1.31 for the same comparison in non-AA donors). Other factors may also exist, but current clinical practices might already mitigate the risks from those factors. As such, we recommend expanding clinical practice to include our findings, but not abandoning current judgment based on factors already perceived to amplify the adverse effects of PCIT.

Original languageEnglish (US)
Pages (from-to)658-666
Number of pages9
JournalAmerican Journal of Transplantation
Issue number3
StatePublished - Mar 2008


  • Cold ischemia
  • Epidemiology
  • Liver transplantation
  • Multivariate analysis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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