Biliary Complications After Liver Transplantation From Maastricht Category-2 Non-Heart-Beating Donors

Suárez, Francisco; Otero, Alejandra; Solla, Miguel; Arnal, F; Lorenzo, Maria J.; Marini, Milagros; Vázquez-Iglesias, J. L.; Gómez, Manuel

doi:10.1097/01.tp.0000297945.83430.ce

Cited by 107 publications

(71 citation statements)

References 22 publications

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“…The risk of NAS is considerably high using DCD, which is associated with NAS in more than 40% of transplantations (64,65). Comparably high rates are reported in ABOincompatible LT, since ABO-antigens are expressed on the biliary epithelial cells.…”

Section: Incidence Of Nasmentioning

confidence: 90%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

257

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Incidence Of Nasmentioning

confidence: 90%

“…In most studies the incidence is not increased (22,25). However, anastomotic complications might be obscured by a high number of diffuse NAS (26).…”

Section: Risk Factors For Anastomotic Complicationsmentioning

confidence: 98%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

257

233

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show abstract

“…In another study a group from La coruna in Spain included category 2 DCD liver donors, they subjected 7 donors to hypothermic regional perfusion and 10 donors to normothermic regional perfusion. The results demonstrated high biliary complication in the recipients (25%) with low rate of five years graft survival [45] .…”

Section: Normothermic Machine Perfusionmentioning

confidence: 90%

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Mahboub¹,

Bozorgzadeh²,

Martins³

2016

WJT

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There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft's for transplantation, improve the outcomes, and decrease the mortality on the waiting list. Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6(2): 314320 Available from: URL:

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“…The ischemic causes may be related or not to hepatic artery thrombosis, other causes being long cold or hot ischemia period, prolonged graft arterialization time, removal of the organ after donor cardiac arrest, excessive use of vasoactive drugs or high age of the donor. Root causes are mostly alo-immune ABO incompatibility, chronic ductopenic rejection, recurrence of underlying disease such as sclerosing cholangitis and autoimmune hepatitis, bile salts toxicity to the epithelium, recurrent viral hepatitis and cytomegalovirus infection (Suarez et al 2008). These types of stenosis, classified as ischemic type, usually are long, multiple, interspersed with areas of dilation and can occur both intra and extra hepatic.…”

Section: Biliary Stricturesmentioning

confidence: 99%

Biliary Complications in Liver Transplantation

Boin¹,

Araújo²,

Ataíde³

et al. 2012

Liver Transplantation - Technical Issues and Complications

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Biliary Complications After Liver Transplantation From Maastricht Category-2 Non-Heart-Beating Donors

Abstract: If this type of donors is accepted as a source of liver organs, the high incidence of biliary complications should be considered and efforts should be made to decrease ischemic injury.

Cited by 107 publications

References 22 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Biliary Complications in Liver Transplantation

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