Evidence map›Paper›PMID 40924859›Full record

ArticleClinical transplantation2025

Pre-Donation Cardiac Arrest and Liver Transplantation Outcomes: Implications for Ischemic Preconditioning.

Dharesh Raj Amarnath, Samuel J Tingle, Georgios Kourounis, Chris Freise, Garrett R Roll, Seiji Yamaguchi, Charles Rickert, Colin H Wilson

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Article in Clinical transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Dharesh Raj AmarnathNewcastle University School of Medicine, Newcastle upon Tyne, UK.ORCID https://orcid.org/0009-0008-9061-8766
Samuel J TingleTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID https://orcid.org/0000-0001-5529-7815
Georgios KourounisTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID https://orcid.org/0000-0002-1051-078X
Chris FreiseDepartment of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California, USA.
Garrett R RollDepartment of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0001-6241-7037
Seiji YamaguchiDepartment of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California, USA.
Charles RickertDepartment of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California, USA.
Colin H WilsonTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLiver transplantation is the definitive treatment for end-stage liver disease and some cancers. The use of livers from donors following pre-donation cardiac arrest (PDCA), especially with prolonged downtime duration, has been limited outside of the US due to fears over inferior outcomes from ischemic injury. However, PDCA may induce ischemic preconditioning, paradoxically improving post-transplant outcomes. We analyzed the impact of PDCA occurrence and downtime duration on liver transplantation.

methodsWe used the UNOS registry on adult liver transplantation (2010-2023), and included both donation after brain death (DBD) and donation after circulatory death (DCD) donors. Multivariable regression models were used to analyze the associations. Multiple imputation was used for missing data, and restricted cubic spline modelling to account for non-linear relationships.

resultsAmong 74,592 recipients, 32,631 (43.7%) received a liver from a PDCA donor. PDCA occurrence was associated with a small improvement in graft survival (aHR = 0.914, 95% Cl = 0.851-0.982). Interaction terms revealed this benefit was more pronounced among the following donor groups: DCD, moderately raised alanine aminotransferase (ALT), short admission-to-donation time and older donors. These novel associations are all in keeping with a preconditioning effect. Increasing PDCA downtime duration was also associated with a small improvement in graft survival (aHR per doubling = 0.953, 95% Cl = 0.917-0.991). Similar associations were seen with secondary outcomes.

conclusionsThe use of livers from donors with PDCA, including those with prolonged downtime duration, is a safe and simple approach to expand the donor pool internationally. Interaction terms and non-linear modelling provided clinical evidence for ischemic preconditioning from PDCA, which represents the largest real-world demonstration of this phenomenon.

Indexed as

End Stage Liver DiseaseHeart ArrestIschemic PreconditioningLiver TransplantationTissue and Organ ProcurementTissue DonorsAdultFemaleFollow-Up StudiesGraft SurvivalHumansMaleMiddle AgedPrognosisRegistriesRisk Factors

Identifiers

PMID40924859
PMCPMC12419763

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.