High peak alanine aminotransferase determines extra risk for nonanastomotic biliary strictures after liver transplantation with donation after circulatory death

Dulk, A. Claire den; Korkmaz, Kerem Sebib; Rooij, Bert-Jan F. de; Sutton, Michael E.; Braat, Andries E.; Inderson, Akin; Dubbeld, Jeroen; Verspaget, Hein W.; Porte, Robert J.; Hoek, Bart van

doi:10.1111/tri.12524

Cited by 24 publications

(22 citation statements)

References 39 publications

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“…Higher postoperative transaminase levels in recipients who develop NAS, however, is in concordance with other studies. (35,36) This further supports the thought that injury, and not increased coagulation, is the leading factor in the pathophysiology of NAS.…”

Section: Discussionsupporting

confidence: 74%

Liver grafts procured from donors after circulatory death have no increased risk of microthrombi formation

Verhoeven¹,

Simon²,

Jonge³

et al. 2016

Liver Transpl

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Microthrombi formation provoked by warm ischemia and vascular stasis is thought to increase the risk of nonanastomotic strictures (NAS) in liver grafts obtained by donation after circulatory death (DCD). Therefore, potentially harmful intraoperative thrombolytic therapy has been suggested as a preventive strategy against NAS. Here, we investigated whether there is histological evidence of microthrombi formation during graft preservation or directly after reperfusion in DCD livers and the development of NAS. Liver biopsies collected at different time points during graft preservation and after reperfusion were triple-stained with hematoxylin-eosin (H & E), von Willebrand factor VIII (VWF), and Fibrin Lendrum (FL) to evaluate the presence of microthrombi. In a first series of 282 sections obtained from multiple liver segments of discarded DCD grafts, microthrombi were only present in 1%-3% of the VWF stainings, without evidence of thrombus formation in paired H & E and FL stainings. Additionally, analysis of 132 sections obtained from matched, transplanted donation after brain death and DCD grafts showed no difference in microthrombi formation (11.3% versus 3.3% respectively; P = 0.082), and no relation to the development of NAS (P = 0.73). Furthermore, no microthrombi were present in perioperative biopsies in recipients who developed early hepatic artery thrombosis. Finally, the presence of microthrombi did not differ before or after additional flushing of the graft with preservation solution. In conclusion, the results of our study derogate from the hypothesis that DCD livers have an increased tendency to form microthrombi. It weakens the explanation that microthrombi formation is a main causal factor in the development of NAS in DCD and that recipients could benefit from intraoperative thrombolytic therapy to prevent NAS following liver transplantation. Liver Transplantation 22 1676-1687 2016 AASLD.

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Section: Discussionsupporting

confidence: 74%

Liver grafts procured from donors after circulatory death have no increased risk of microthrombi formation

Verhoeven¹,

Simon²,

Jonge³

et al. 2016

Liver Transpl

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“…Interestingly, the incidence of NAS in pediatric DCD livers was considerably lower than that reported in adult DCD livers [19,28–30]. Although it is widely accepted that NAS is the most relevant and prevalent complication of adult DCD livers, this study indicates that this is not the case for pediatric DCD livers.…”

Section: Discussioncontrasting

confidence: 62%

Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

et al. 2017

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BackgroundLiver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD) donors.MethodAll transplantations performed with a liver from a pediatric donor (≤16 years) in the Netherlands between 2002 and 2015 were included. Patient survival, graft survival, and complication rates were compared between DCD and DBD liver transplantation.ResultsIn total, 74 liver transplantations with pediatric grafts were performed; twenty (27%) DCD and 54 (73%) DBD. The median donor warm ischemia time (DWIT) was 24 min (range 15–43 min). Patient survival rate at 10 years was 78% for recipients of DCD grafts and 89% for DBD grafts (p = 0.32). Graft survival rate at 10 years was 65% in recipients of DCD versus 76% in DBD grafts (p = 0.20). If donor livers in this study would have been rejected for transplantation when the DWIT ≥30 min (n = 4), the 10-year graft survival rate would have been 81% after DCD transplantation. The rate of non-anastomotic biliary strictures was 5% in DCD and 4% in DBD grafts (p = 1.00). Other complication rates were also similar between both groups.ConclusionsTransplantation of livers from pediatric DCD donors results in good long-term outcome especially when the DWIT is kept ≤30 min. Patient and graft survival rates are not significantly different between recipients of a pediatric DCD or DBD liver. Moreover, the incidence of non-anastomotic biliary strictures after transplantation of pediatric DCD livers is remarkably low.

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“…A recent study from the Netherlands reported on 97 DCD liver recipients with a median asystolic donor warm ischemia of 17 minutes and a donor age of 44 years. The incidence of nonanastomotic biliary strictures cumulated in this analysis to 31%, 38 with a strong correlation between the degree of initial reperfusion injury (peak ALT) and subsequent biliary injury. This observation underlines the importance of the initial ischemia-reperfusion injury before implantation, which, for example, can be prevented by machine perfusion techniques.…”

Section: Discussionmentioning

confidence: 89%

First Comparison of Hypothermic Oxygenated PErfusion Versus Static Cold Storage of Human Donation After Cardiac Death Liver Transplants

et al. 2015

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High peak alanine aminotransferase determines extra risk for nonanastomotic biliary strictures after liver transplantation with donation after circulatory death

Cited by 24 publications

References 39 publications

Liver grafts procured from donors after circulatory death have no increased risk of microthrombi formation

Liver grafts procured from donors after circulatory death have no increased risk of microthrombi formation

Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

First Comparison of Hypothermic Oxygenated PErfusion Versus Static Cold Storage of Human Donation After Cardiac Death Liver Transplants

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