Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death Donors

Croome, Kris P.; McAlister, Vivian C.; Adams, Paul C.; Marotta, Paul; Wall, William; Hernandez‐Alejandro, Roberto

doi:10.1155/2012/346286

Cited by 29 publications

(22 citation statements)

References 24 publications

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“…An 'ischemic cholangiopathy' evolves in >20% of recipients (79). The clinical picture is similar to NAS of other etiology, but it manifests regularly within 3 months after LT (78). Its clinical course is often more severe and retransplantation required in a significant percentage (79,80).…”

Section: Special Issues Of Dcdmentioning

confidence: 96%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Special Issues Of Dcdmentioning

confidence: 96%

“…During the additional period of WIT without organ preservation stasis and thrombus formation in small vessels is expedited (77). Since also the peribiliary plexus is involved, the incidence of biliary complications is almost doubled (78). An 'ischemic cholangiopathy' evolves in >20% of recipients (79).…”

Section: Special Issues Of Dcdmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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“…24 Additionally, many single-center studies ( Table 2) have suggested that both graft function and patient survival are comparable between DCD and DBD liver transplants. [25][26][27][28][29] Meurisse and associates reported DCD liver transplants had 1, 3, and 5-year graft survival rates of 90%, 82%, and 82% and patient survival rates of 93%, 85%, and 85%, which were similar to DBD liver transplant survival rates of 85%, 74%, and 68% (P = .524) and patient survival rates of 88%, 78%, and 72% (P = .348). 25 Grewal and associates were able to achieve comparable longterm outcomes between DCD and DBD liver transplants with 1-, 3-, and 5-year patient and graft survival rates for DCD transplants (91.5%, 88.1%, and 88.1% and 79.3%, 74.5%, and 71.0%) vs DBD transplants (87.3%, 81.1%, and 77.2% and 81.6%, 74.7%, and 69.1%).…”

Section: Discussionmentioning

confidence: 71%

“…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).…”

Section: Emre a Eren Et Al/experimental And Clinical Transplantationmentioning

confidence: 99%

“…31 Several recipient characteristics can increase the risk of poor DCD outcomes, including high Model for End-stage Liver Disease scores, which have been associated with graft failure and biliary complications in some studies, whereas other studies refute this claim. 26,38,39 In addition, hepatitis C viruspositive recipients may be at increased risk for hepatitis C virus recurrence. 40,41 Recently, Croome and associates found that transplant recipients with hepatocellular carcinoma may have inferior survival rates after DCD transplant (P = .049).…”

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confidence: 99%

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Untitled

2016

Exp Clin Transplant

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The supply of liver grafts for treatment of end-stage liver disease continues to fall short of ongoing demands. Currently, most liver transplants originate from donations after brain death. Enhanced utilization of the present resources is prudent to address the needs of the population. Donation after circulatory or cardiac death is a mechanism whereby the availability of organs can be expanded. Donations after circulatory death pose unique challenges given their exposure to warm ischemia. Technical principles of donations after circulatory death procurement and pertinent studies investigating patient outcomes, graft outcomes, and complications are highlighted in this review. We also review associated risk factors to suggest potential avenues to achieve improved outcomes and reduced complications. Future considerations and alternative techniques of organ preservation are discussed, which may suggest novel strategies to enhance preservation and donor expansion through the use of marginal donors. Ultimately, without effective measures to bolster organ supply, donations after circulatory death should remain a consideration; however, an understanding of inherent risks and limitations is necessary.

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Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity‐matched cohort

et al. 2017

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The use of liver grafts from donation after cardiac death (DCD) has been limited due to the increased rate of graft failure, mostly related to ischemic cholangiopathy (IC). It is our hypothesis that longterm outcomes and quality of life (QOL) similar to patients undergoing liver transplantation (LT) with donation after brain death (DBD) can be achieved. Clinical outcomes of all patients undergoing DCD LT (n = 300) between 1998 and 2015 were compared with a propensity score-matched cohort of patients undergoing DBD LT (n = 300). Patients were contacted for a follow-up questionnaire and short-form (SF)-12 QOL Survey administration. Median follow-up was >5 years. Graft survival at 1-, 3-, and 5-years was 83.8%, 75.5%, and 70.1% in the DCD LT group and 88.4%, 80.3%, and 73.9% in the DBD LT group (P = 0.27). Patient survival at 1-, 3-, and 5-years was 92.3%, 86.1%, and 80.3% in the DCD LT group and 92.3%, 85.1%, and 79.5% in the DBD LT group (P = 0.81). IC developed in 11.7% and 2% of patients in the DCD LT group and DBD LT group, respectively (P < 0.001). DCD LT recipients who developed IC had inferior graft survival compared with both the DCD non-IC group (P < 0.001) and the DBD LT group (P < 0.001); no difference in graft survival was observed between the DCD non-IC group and the DBD LT group (P = 0.50). Physical and Mental Composite Scores on the SF-12 QOL questionnaire were similar between the DCD LT and DBD LT groups (44.0 versus 45.4; P = 0.34 and 51.9 versus 52.2; P = 0.83), respectively. Similar longterm survival and QOL scores can be achieved between DCD LT and DBD LT. Prevention of IC in DCD LT yields excellent graft and patient survival with virtually no difference compared with DBD LT. Liver Transplantation 23 342-351 2017 AASLD.

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Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death Donors

Cited by 29 publications

References 24 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Untitled

Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity‐matched cohort

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