Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death

DeOliveira, Michelle L.; Jassem, Wayel; Valente, Umberto; Khorsandi, Shirin Elizabeth; Santori, Gregorio; Prachalias, Andreas; Srinivasan, Parthi; Rela, Mohamed; Heaton, Nigel

doi:10.1097/sla.0b013e318235c572

Cited by 146 publications

(164 citation statements)

References 42 publications

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“…However, our presented data along with other recent reports (21)(22)(23) may suggest otherwise. (23) This prompted us to ask the following questions: how many young DCD livers are discarded annually, and would more frequent acceptance of younger DCD livers increase the number of liver transplants in the United States?…”

Section: Scalea Redfield and Foley Liver Transplantation Septembercontrasting

confidence: 40%

Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

2016

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Multiple reports have demonstrated that liver transplantation following donation after circulatory death (DCD) is associated with poorer outcomes when compared with liver transplantation from donation after brain death (DBD) donors. We hypothesized that carefully selected, underutilized DCD livers recovered from younger donors have excellent outcomes. We performed a retrospective study of the United Network for Organ Sharing database to determine graft survivals for patients who received liver transplants from DBD donors of age 60 years, DBD donors < 60 years, and DCD donors < 50 years of age. Between January 2002 and December 2014, 52,271 liver transplants were performed in the United States. Of these, 41,181 (78.8%) underwent transplantation with livers from DBD donors of age < 60 years, 8905 (17.0%) from DBD donors 60 years old, and 2195 (4.2%) livers from DCD donors < 50 years of age. DCD livers of age < 50 years with < 6 hours of cold ischemia time (CIT) had superior graft survival when compared with DBD livers age 60 years (P < 0.001). In 2014, there were 133 discarded DCD livers; of these, 111 (83.4%) were from donors < age 50 years old. Young DCD donor livers (age < 50 years old) with short CITs yield results better than that seen with DBD livers > 60 years old. Careful donor organ and recipient selection can lead to excellent results, despite previous reports suggesting otherwise. Increased acceptance of these DCD livers would lead to shorter wait list times and increased national liver transplant rates.Liver Transplantation 22 1197-1204 2016 AASLD. There exists a vast disparity between the number of patients on the liver transplant waiting list and the number of available organs.(1-4) One method for increasing the number of transplantable organs has been to use organs from patients who die after circulatory death.(5-9) Accordingly, large increases in the number of transplantable kidneys have resulted from donation after circulatory death (DCD) protocols. However, only modest increases in DCD liver transplantation have been observed. (5,10,11) In fact, only approximately 6% of liver transplants in the United States are performed using DCD livers.(12) This lack of growth in the DCD liver pool is due, in part, to the technical challenges of the operation and concern for postoperative complications such as ischemic cholangiopathy. (5,6) As described by Feng et al., (13) not all donor livers yield equivalent recipient outcomes. Much like livers that are recovered from donation after brain death (DBD) donors, DCD livers carry a spectrum of risk. That is, there are some livers which likely function better than others. It is known that the age of the DCD donor is a risk factor for graft loss when compared with DBD organs, particularly when the DCD donor is >50 years of age. (13,14) In addition, cold ischemia time (CIT) has been shown to have a greater effect on Abbreviations: BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after circulatory death; ICU, intensive ca...

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Section: Scalea Redfield and Foley Liver Transplantation Septembercontrasting

confidence: 40%

Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

2016

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“…The reported incidence of biliary strictures after DCD liver transplantation encompasses a wide range of variability ranging from 8% to 38% (mean 16%) with a recent report indicating an extremely low IC incidence of 2.5% (17,18). Likely, the wide variation seen not only represents a true difference based on variable local conditions but also variable definitions of IC and potentially variable aggressiveness in diagnosis of biliary strictures after liver transplantation.…”

Section: Discussionmentioning

confidence: 94%

Differential Rates of Ischemic Cholangiopathy and Graft Survival Associated With Induction Therapy in DCD Liver Transplantation

Halldorson

Bakthavatsalam

Montenovo

et al. 2015

American Journal of Transplantation

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Transplantation utilizing donation after circulatory death (DCD) donors is associated with ischemic cholangiopathy (IC) and graft loss. The University of Washington (UW) DCD experience totals 89 DCD liver transplants performed between 2003 and 2011. Overall outcome after DCD liver transplantation at UW demonstrates Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively, with the great majority of patient and graft losses occurring in the first-year posttransplant from IC. Our program has almost exclusively utilized either antithymocyte globulin (ATG) or basiliximab induction (86/ 89) for DCD liver transplantations. Analysis of the differential effect of induction agent on graft survival demonstrated graft survival of 96.9% at 1 year for ATG versus 75.9% for basiliximab (p ¼ 0.013). The improved survival did not appear to be from a lower rate of rejection (21.9% vs. 22.2%) but rather a differential rate of IC, 35.2% for basiliximab versus 12.5% for ATG (p ¼ 0.011). Multivariable analysis demonstrated induction agent to be independently associated with graft survival and IC free graft survival when analyzed against variables including donor age, fWIT, donor cold ischemia time and transplant era.

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“…9 These results correlate with another DCD series reporting only 2.5% IC in 167 DCD livers, exposed to a mean of 7 hours cold storage, together with functional warm ischemia of less than 20 minutes (mean 16 minutes). 10 In contrast, an increase in the asystolic to cross-clamp duration above 9 minutes is associated with a severe increase in the odds for the development of IC or hepatic necrosis by 16% per minute. 11 Based on this, it is rather unlikely that the very low incidence of IC in our HOPE-treated patients is related to short cold storage, in the presence of an extended donor warm ischemia (asystolic to crossclamp duration 18 minutes).…”

mentioning

confidence: 96%

Reply to “Reducing Nonanastomotic Biliary Strictures in Donation After Circulatory Death Liver Transplantation

et al. 2017

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Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death

Abstract: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.

Cited by 146 publications

References 42 publications

Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

Differential Rates of Ischemic Cholangiopathy and Graft Survival Associated With Induction Therapy in DCD Liver Transplantation

Reply to “Reducing Nonanastomotic Biliary Strictures in Donation After Circulatory Death Liver Transplantation

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