Time Matters More Than Distance: The Impact of Transport Logistics on Total Ischemic Time and Survival After Deceased-Donor Liver Transplantation.

BACKGROUND: Total ischemic time (TIT) is a key determinant of outcomes after deceased-donor liver transplantation (DDLT). In Japan, the nationwide organ allocation system, which does not include regional prioritization, often requires long-distance graft transport. However, the contributions of transport time, distance, and modality to TIT and post-transplant outcomes have not been fully clarified. METHODS: We performed a nationwide retrospective cohort study of DDLT cases in Japan between July 2019 and December 2023 using data from the Japan Organ Transplant Network. Associations among transport-related factors, TIT, and post-transplant outcomes were assessed. RESULTS: Among the 415 transplant recipients, TIT was significantly correlated with both transport time and transport distance (p < 0.01), although the strength of these correlations varied according to transport modality. Strong correlations were observed for ground and high-speed rail transportation, whereas the correlation was weaker for air transportation. Restricted cubic spline analyses demonstrated strong, monotonic associations between prolonged TIT and increased mortality risk and between prolonged transport time and mortality risk. Prolonged TIT was independently associated with poorer survival in the multivariable analysis, whereas transport time and modality were not. In the analyses stratified by the combination of TIT and transport time, favorable outcomes were observed in cases with a prolonged transport time when TIT was maintained at a lower level. CONCLUSION: Prolonged transport time contributes to increased TIT; however, optimization of perioperative management to minimize TIT may preserve post-transplantation outcomes in long-distance transplantation.