Intraoperative High Fraction of Inspiratory Oxygen is Independently Associated with Worse Outcome After Living-Donor Liver Transplantation: A Retrospective Study

BACKGROUND: Ischemia and reperfusion injury is an important factor that determines graft function after liver transplantation, and oxygen plays a crucial role in this process. However, the relationship between the intraoperative high fraction of inspiratory oxygen (FiO(2)) and living-donor-liver-transplantation (LDLT) outcome remains unclear. PATIENTS AND METHODS: A total of 199 primary adult-to-adult LDLT cases in Kyoto University Hospital between January 2010 and December 2017 were enrolled in this study. The intraoperative FiO(2) was averaged using the total amount of intraoperative oxygen and air and defined as the calculated FiO(2) (cFiO(2)). The cutoff value of cFiO(2) was set at 0.5. RESULTS: Between the cFiO(2) <0.5 (n = 156) and ≥0.5 group (n = 43), preoperative recipients’ background, donor factors, and intraoperative parameters were almost comparable. Postoperatively, the cFiO(2) ≥0.5 group showed a higher early allograft dysfunction (EAD) rate (P = 0.049) and worse overall graft survival (P = 0.036) than the cFiO(2) <0.5 group. Although the cFiO(2) ≥0.5 was not an independent risk factor for EAD in multivariable analysis (OR 2.038, 95%CI 0.992–4.186, P = 0.053), it was an independent risk factor for overall graft survival after LDLT (HR 1.897, 95%CI 1.007–3.432, P = 0.048). CONCLUSION: The results of this study suggest that intraoperative high FiO(2) may be associated with worse graft survival after LDLT. Avoiding higher intraoperative FiO(2) may be beneficial for LDLT recipients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-022-06544-7.