National Assessment of Early Biliary Complications After Liver Transplantation

Axelrod, David A.; Dzebisashvilli, Nino; Lentine, Krista L.; Xiao, Huiling; Tuttle‐Newhall, Janet E.; Segev, Dorry L.

doi:10.1097/tp.0000000000000197

Cited by 19 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This also has serious implications for healthcare economy. A recent analysis of a large dataset with more than 12800 liver transplantations could show that biliary complications in recipients receiving a graft after brain death donation were responsible for an increment of cost of nearly 55000$ in the first post-transplant year[ 3 ]. These findings could be confirmed in the following post-transplant years as well as in donation after cardiac death transplantations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors

Kaltenborn¹,

Gutcke²,

Gwiasda³

et al. 2017

WJH

View full text Add to dashboard Cite

AIMTo identify independent risk factors for biliary complications in a center with three decades of experience in liver transplantation.METHODSA total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease (MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logistic regression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate.RESULTSBiliary complications were observed in 227 cases (14.1%). Four hundred and seventeen (26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21% (n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46% (n = 41)], anastomotic strictures [25% (n = 22)], cholangitis [8% (n = 7)] and non-anastomotic strictures [3% (n = 3)]. The remaining 18% (n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation (P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively (P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation (P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of 0.702.CONCLUSIONThe parallel occurrence of high recipient MELD and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Diverse studies reveal their notable association with mortality and an overall incidence of 10%-40% is described[ 2 ]. Moreover, the socio-economic implications due to prolonged morbidity are of increasing relevance and represent a serious burden to health care systems[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors

Kaltenborn¹,

Gutcke²,

Gwiasda³

et al. 2017

WJH

View full text Add to dashboard Cite

show abstract

“…The FWIT increases the recipient's risk of postreperfusion syndrome , primary nonfunction, delayed graft function , ischemic cholangiopathy (IC) , and acute and chronic kidney disease . The cost of DCD transplants can also be 50% higher; IC, for example, is associated with a higher readmission rate, multiple invasive procedures and, in some cases, retransplantation .…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score–Matched Study From a Single Center

Laing

Scalera

Isaac

et al. 2016

American Journal of Transplantation

122

120

View full text Add to dashboard Cite

The use of livers from donation after circulatory death (DCD) is increasing, but concerns exist regarding outcomes following use of grafts from "marginal" donors. To compare outcomes in transplants using DCD and donation after brain death (DBD), propensity score matching was performed for 973 patients with chronic liver disease and/or malignancy who underwent primary whole-liver transplant between 2004 and 2014 at University Hospitals Birmingham NHS Foundation Trust. Primary end points were overall graft and patient survival. Secondary end points included postoperative, biliary and vascular complications. Over 10 years, 234 transplants were carried out using DCD grafts. Of the 187 matched DCDs, 82.9% were classified as marginal per British Transplantation Society guidelines. Kaplan-Meier analysis of graft and patient survival found no significant differences for either outcome between the paired DCD and DBD patients (p = 0.162 and p = 0.519, respectively). Aspartate aminotransferase was significantly higher in DCD recipients until 48 h after transplant (p < 0.001). The incidences of acute kidney injury and ischemic cholangiopathy were greater in DCD recipients (32.6% vs. 15% [p < 0.001] and 9.1% vs. 1.1% [p < 0.001], respectively). With appropriate recipient selection, the use of DCDs, including those deemed marginal, can be safe and can produce outcomes comparable to those seen using DBD grafts in similar recipients.

show abstract

“…Medicare billing claims include diagnostic and procedure codes as well as total payments for patients with Medicare fee for service primary or secondary insurance. Data linkage was performed as previously described (21,23). The cohort was restricted to patients noted to have Medicare as the primary insurer in the OPTN records at the time of transplantation with an appropriate charge for the transplant procedure.…”

Section: Data Sources and Study Samplementioning

confidence: 99%

Variation in Biliary Complication Rates Following Liver Transplantation: Implications for Cost and Outcome

Axelrod

Dzebisashvili

Lentine

et al. 2015

American Journal of Transplantation

View full text Add to dashboard Cite

Although biliary complications (BCs) have a significant impact on the outcome of liver transplantation (LT), variation in BC rates among transplant centers has not been previously analyzed. BC rate, LT outcome and spending were assessed using linked Scientific Registry of Transplant Recipients and Medicare claims (n ¼ 16 286 LTs). Transplant centers were assigned to BC quartiles based upon risk-adjusted observed to expected (O:E) ratio of BC separately for donation after brain death (DBD) and donation after cardiac death (DCD) donors. The median incidence of BC was 300% greater in the highest versus lowest DBD quartiles (19.0% vs. 5.9%) and varied 250% between DCD quartiles (20.3%-8.4%). Donor and recipient characteristics suggest that high BC centers actually used lower donor risk index organs, fewer split livers and fewer imports (p < 0.001 for all). Transplant at a center in the highest O:E quartile was associated with increased posttransplant mortality (adjusted hazard ratio [aHR] 2.53, p ¼ 0.007) in DCD transplant and increased graft loss (aHR 1.21, p ¼ 0.02) in DBD transplant. Medicare spending was $22 895 (p < 0.0001) higher at centers in highest versus lowest BC quartile. In summary, BC rates vary widely among transplant centers and higher rates are a marker for an increased risk of death, graft failure and health-care spending.

show abstract

National Assessment of Early Biliary Complications After Liver Transplantation

Abstract: This national study of biliary complications demonstrates the significant economic impact of this common perioperative complication and suggests a potential target for quality of care improvements.

Cited by 19 publications

References 25 publications

Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors

Biliary complications following liver transplantation: Single-center experience over three decades and recent risk factors

Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score–Matched Study From a Single Center

Variation in Biliary Complication Rates Following Liver Transplantation: Implications for Cost and Outcome

Contact Info

Product

Resources

About