TY - JOUR
T1 - Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death
T2 - Results from a Matched Control Study in a Single Large Volume Center
AU - DeOliveira, Michelle L.
AU - Jassem, Wayel
AU - Valente, Roberto
AU - Khorsandi, Shirin Elizabeth
AU - Santori, Gregorio
AU - Prachalias, Andreas
AU - Srinivasan, Parthi
AU - Rela, Mohamed
AU - Heaton, Nigel
PY - 2011/11
Y1 - 2011/11
N2 - Objective: To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution.Background: Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs.Methods: A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months.Results: Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively).Conclusions: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.
AB - Objective: To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution.Background: Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs.Methods: A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months.Results: Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively).Conclusions: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.
KW - HEART-BEATING DONORS
KW - CONTROLLED NONHEARTBEATING DONORS
KW - BILE-DUCT CELLS
KW - ISCHEMIC CHOLANGIOPATHY
KW - SURGICAL COMPLICATIONS
KW - CONTROLLED DONATION
KW - PRACTICE GUIDELINES
KW - REPERFUSION INJURY
KW - CENTER EXPERIENCE
KW - ORGAN DONATION
U2 - 10.1097/SLA.0b013e318235c572
DO - 10.1097/SLA.0b013e318235c572
M3 - Article
SN - 0003-4932
VL - 254
SP - 716
EP - 723
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -