Liver Transplantation from Donor after Cardiac Death (DCD) Maastricht type IIA, our Experience after 10 years

Delgado, M.; Alonso, Iago Justo; Nutu, Oana Anisa; González, Marina Pérez-Flecha; Elso, Pilar Del Pozo; Alonso, Isabel Lechuga; Municio, Alejandro Manrique; Maestro, Óscar Caso; Quinto, Alberto Marcacuzco; Murillo, Laura Alonso; Pulido, Jorge Calvo; Molero, Félix Cambra; Pérez-Fuentes, Álvaro García-Sesma; Vázquez, Cristina Cobo; Segurola, Carmelo Loinaz; Romero, Carlos García-Sesma

doi:10.1097/01.tp.0000543151.82018.be

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“…[8][9][10][11][12][13] Donation after circulatory death organs have increased rates of biliary complications, and specifically ischemic cholangiopathy, compared to their DBD counterparts. 12,[14][15][16][17][18] Careful donor selection and earlier identification and treatment of biliary complications has also been shown to improve outcomes using DCD organs. 12,17,19 Biliary complications remain a significant driver of morbidity and mortality in DCD liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Single Center Experience with Incidence, Impact and Predictors of Biliary Complications in Donation After Circulatory Death Liver Transplantation

et al. 2022

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Introduction: Utilizing allografts from donors after cardiac death (DCD) has improved organ availability, and DCD livers comprise a growing proportion of transplantations. However, it has been suggested that DCD transplantations have worse outcomes. Research Questions: We aimed to characterize outcomes in a large cohort of DCD transplantations, identify trends in outcomes over time, and identify factors associated with the development of biliary complications. Design: We conducted an observational retrospective cohort study of patients receiving DCD liver allografts within a large academic teaching hospital with a high transplantation volume. Consecutive patients who underwent Type III DCD liver transplantation from 2006–2016 were included in our cohort. Re-transplantations and multi-organ transplant recipients were excluded. Results: Ninety-six type III DCD transplantations occurred between 2006–2016. We report a 1one-year patient survival of 90.6% (87) and a 5five-year patient survival of 69.8% (67). Twenty-nine (30.2%) patients experienced any biliary complication in the first year following discharge, with 17 (17.7%) experiencing ischemic cholangiopathy. Five-year patient (P = 0.04) and graft (P = 0.005) survival improved over time. Post-operative biliary complications experienced during index admission and prior to discharge were found to be associated with the development of biliary complications (P = 0.005) and ischemic cholangiopathy (P = 0.01) following discharge. Conclusion: Our data suggested that outcomes using DCD allografts have improved, however biliary complications remain a significant issue in DCD transplantation. Patients who experienced post-operative biliary complications during index admission may require more frequent screening to allow the initiation of earlier treatment for biliary complications.

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