A severely cholestatic liver graft can be successfully used in deceased donor liver transplantation

Abstract

The shortage of deceased organs is still a serious issue in Japan. A proactive approach to using liver grafts from extended criteria donors (ECDs) may be one way of expanding the donor pool; however, if it is recklessly attempted, a recipient receiving such a marginal graft can be at risk of mortality due to primary non-function or delayed graft function. We herein report the successful outcome of a recipient receiving a severely cholestatic graft that was considered transplantable because it lacked features characteristic of a long duration of "cholestasis" according to the precise interpretation of a donor biopsy. Plasma exchange was intentionally introduced to prevent toxic insult by hyperbilirubinemia immediately after transplant. Despite transient acute kidney injury immediately after transplant, the patient's renal impairment was well managed with a renal-sparing immunosuppressive regimen consisting of basiliximab and mycophenolate mofetil. Although the use of liver grafts from ECDs still needs to be discussed, especially regarding graft selection and allocation policies, efforts not to discard valuable grafts should be undertaken in our country.

Cholemic Nephropathy as Cause of Acute and Chronic Kidney Disease. Update on an Under-Diagnosed Disease

“…The cases of AKI described in the context of sHyb usually correspond to the most severe cases, associated to the higher values of sCr reported or to the need for dialysis [3,16,48,[63][64][65][66][67][68][69][70][71][72][73][74].…”

“…Three cases described AKI in the context of sHyb after liver transplantation [68,72,73]. In all cases the authors did not search for the presence of bile casts on urine examination neither evaluated the presence of BCPFs including CNI therapy.…”

“…In all cases the authors did not search for the presence of bile casts on urine examination neither evaluated the presence of BCPFs including CNI therapy. In two cases the authors considered other diagnostic hypotheses of AKI (HRS, sepsis) out of CN despite sHyb and the renal biopsy not being performed [68,73]. In the third case the renal biopsy was performed and the diagnosis of CN carried out on the basis of abundant pigmented casts positive on Hall's stain noted in the distal tubules and loss of the brush borders in the proximal tubules [72].…”

A marginal liver graft with hyperbilirubinemia transplanted successfully by ischemia-free liver transplantation

“…IRI can also cause damage to other organs, leading to complications such as postreperfusion syndrome (PRS) and acute kidney injury (AKI) (6). The tolerance to hypoxia and IRI in ECD or marginal donor livers is worse than that of high-quality allografts, leading to a higher incidence of IRI-related complications (7,8).…”