Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors

Abstract

The use of donation after cardiac death (DCD) donor hepatic allografts is becoming more widespread; however, there have been published reports of increased graft failure from specific complications associated with this type of allograft. The complication of ischemic cholangiopathy (IC) has been reported to occur more frequently after the use of DCD hepatic allografts. We report the results of 52 liver transplants from DCD donors and the factors that influenced the development of IC. We conducted a retrospective review of all DCD and donation after brain death (DBD) donor liver recipients from September 2003 through December 2006 at a single institution. Survival and complication rates were compared between the 2 groups. The Cox proportional hazards model was then used to identify recipient and donor factors that predict the development of IC in the DCD group. There was no difference in 1-year patient or graft survival rates between the 2 groups. There was no incidence of primary nonfunction from the DCD allografts. Hepatic artery complications and anastomotic bile duct complications were comparable in the 2 groups. There was, however, an increased risk for the development of IC in the DCD group (13.7% versus 1%, P ϭ 0.001). Donor weight Ͼ100 kg and total ischemia times Ն9 hours, in donors older than 50 years of age, predicted the development of IC in the DCD group. In conclusion, there is a higher incidence of IC in recipients receiving DCD donor livers; however, patient and graft outcomes with DCD donors remain comparable to those with DBD donors. Careful donor selection may improve utilization of these grafts. Liver Transpl 14: 604-610, 2008.

Non heart beating organ donor: new experimental model in pigs

“…The most important issue regarding this modality is the gap between an insufficient pool of organ donors and the increasing number of potential recipients 1,3 .…”

“…Therefore, organs from non heart beating donors (NHBD) can be suitable for transplantation, regardless of a worse first year graft survival outcome 1,2,4,9 . Contemporary aspects of organ donation after cardiac death have stimulated the development of experimental models aiming the improvement of preservation and organ dysfunction 2,6,7 .…”

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“…6,[12][13][14][16][17][18]25,[28][29][30] Foley and coworkers 13 reported that rates of overall biliary complications (DCD, 47%; DBD, 26%; P < .01) and IC (DCD, 34%; DBD, 1%; P < .01) were significantly higher in the DCD group. Research conducted by Chan and associates 28 indicated no incidence of PNF from DCD allografts. Hepatic artery complications and anastomotic bile duct complications were comparable in the 2 groups.…”

“…Previous publications have sought to identify risk factors for the development of IC in DCD grafts (Table 5). 12,13,28,31 In addition, a higher incidence of intrahepatic bile duct strictures (IHBS) of 16% following DCD liver transplant, compared with 3% in DBD recipients, was recently reported. 29 The DCD recipients had 10.8-fold increased odds of presenting with IHBS.…”

“…13,28 However, single-center analyses have provided conflicting findings about complications in DCD recipients. In some studies, the frequencies of PNF, 14,19,28 hepatic artery thrombosis, 14,16,19,28,32 and acute rejection 15,19,32 after DCD liver transplant did not seem significantly higher than those after DBD liver transplant. Taking a study by DeOliveira and associates 33 as an example, primary IC occurred only in 4 recipients (2.5%) from the DCD group (n = 167) and was absent in the DBD group (n = 333).…”