Liver transplantation from controlled non–heart-beating donors: an increased incidence of biliary complications

Abt, Peter L.; Crawford, Michael; Desai, Niraj M.; Markmann, James F.; Olthoff, Kim M.; Shaked, Abraham

doi:10.1097/01.tp.0000062574.18648.7c

Cited by 287 publications

(250 citation statements)

References 22 publications

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“…The use of NHBD grafts has been previously shown to lead to a higher incidence of biliary complications. [19][20][21] A recent study from Johns Hopkins revealed the presence of biliary casts, proximal to ductal anastomotic strictures, in 35% of its NHBD liver transplants. 22 A possible reason that our current study did not show an increased incidence of BCS in NHBD grafts is the limited sample size.…”

Section: Discussionmentioning

confidence: 99%

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

et al. 2008

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Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

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Section: Discussionmentioning

confidence: 99%

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

et al. 2008

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“…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: 99%

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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“…Complications in groups with WIT less than 30 min were similar, the incidence of liver graft dysfunction increased with the elongation of WIT and the incidence of biliary blockage was positively related to the survival time of recipient animals [22][23][24] .…”

Section: Relationship Between Wit and Complicationmentioning

confidence: 99%

Safe time to warm ischemia and posttransplant survival of liver graft from non-heart-beating donors

He¹

2004

WJG

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AIM:To explore the dynamical changes of histology, histochemistry, energy metabolism, liver microcirculation, liver function and posttransplant survival of liver graft in rats under different warm ischemia times (WIT) and predict the maximum limitation of liver graft to warm ischemia. METHODS:According to WIT, the rats were randomized into 7 groups, with WIT of 0, 10, 15, 20, 30, 45, 60 min, respectively. The recovery changes of above-mentioned indices were observed or measured after liver transplantation. The graft survival and postoperative complications in each subgroup were analyzed. RESULTS:Liver graft injury was reversible and gradually resumed normal structure and function after reperfusion when WIT was less than 30 min. In terms of graft survival, there was no significant difference between subgroups within 30 min WIT. When WIT was prolonged to 45 min, the recipients' long-term survival was severely insulted, and both function and histological structure of liver graft developed irreversible damage when WIT was prolonged to 60 min. CONCLUSION:The present study indicates that rat liver graft can be safely subjected to warm ischemia within 30 min. The levels of ATP, energy charge, activities of glycogen, enzyme-histochemistry of liver graft and its recovery potency after reperfusion may serve as the important criteria to evaluate the quality of liver graft.

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Liver transplantation from controlled non–heart-beating donors: an increased incidence of biliary complications

Abstract: Donor warm ischemic time may predispose hepatic allografts to an increased incidence of ischemic type strictures. Although graft and patient survival was similar to a cohort of HBD recipients, caution is urged with the use of these organs.

Cited by 287 publications

References 22 publications

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Safe time to warm ischemia and posttransplant survival of liver graft from non-heart-beating donors

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