Biliary complications and outcomes of liver transplantation from donors after cardiac death

Abstract

Biliary complications after liver transplantation (LT) using organs retrieved from donors after cardiac death are not well characterized. The aim of this study was to evaluate the severity of biliary complications and outcomes after donation after cardiac death liver transplantation (DCD-LT). A retrospective evaluation of 20 DCD-LTs from 1997-2006 was performed. The recipient age was 53 Ϯ 8.7, and the donor age was 35 Ϯ 11 years. The warm ischemia time, cold ischemia time, peak alanine aminotransferase level, and peak aspartate aminotransferase level were 33 Ϯ 12 minutes, 8.7 Ϯ 2.7 hours, 1757 Ϯ 1477 U/L, and 4020 Ϯ 3693 U/L, respectively. The bilirubin and alkaline phosphatase levels at hospital discharge after LT were 3.2 Ϯ 5.4 mg/dL and 248 Ϯ 200 U/L, respectively. During a median follow-up of 7.5 months (range: 1-73), 5 patients (25%; 1 death after re-LT) died (3 from sepsis, 1 from recurrent hepatocellular carcinoma at 4 months, and 1 from a cardiac event at 46 months), and additionally, 4 patients (20%) required re-LT (1 because of hepatic artery thrombosis, 1 because of primary graft nonfunction, and 2 because of biliary strictures). Twelve (60%) developed biliary complications, and of these, 11 (55%) had serious biliary complications. The biliary complications were as follows: a major bile leak for 2 patients (10%; both eventually underwent retransplantation), anastomotic strictures for 5 patients (25%), hilar strictures for 7 patients (35%), extrahepatic donor duct strictures for 9 patients (45%), intrahepatic strictures for 10 patients (50%), stones for 1 patients (5%), casts for 7 patients (35%), and debris for 2 patients (10%). More than 1 biliary complication was seen in most patients, and these were unpredictable and required multiple diagnostic or therapeutic procedures. Serious biliary complications are common after DCD-LT, and research should focus on identifying donor and recipient factors that predict and prevent serious biliary complications.

Bile duct stones and casts after liver transplantation: Different entities but similar prevention strategy?

“…[15][16][17] Consistently, in a recent retrospective cohort analysis focusing on biliary complication after LT from DCD, cast formation occurred in 7 out of 20 cases (35%). 18 In that study, WIT was higher than in other reports. 15,16,19 Sample size bias may justify the lack of significance of cast prevalence in other similar studies.…”

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

“…[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. Our data set included only 6 patients (2 BCS and 4 controls) with NHBD grafts.…”

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“…20,25,26,44 A single-center study showed an overall biliary complication rate of 50% for DCDs versus 28.3% for DBDs (P = .012) with biliary stricture rates of 46.7% and 26.5% (P = .018). 25 Croome and associates reported that 25% of DCD liver transplants developed biliary complications compared with 13% of DBD liver transplants (P = .062).…”