Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death

In Brief Objective: To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution. Background: Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs. Methods: A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months. Results: Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively). Conclusions: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia. To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD), a retrospective analysis of a single large institution's prospective database was performed in which 167 consecutive DCD-LT (liver transplantation) were matched with 2 DBD (brain death donor) grafts. Patient and graft survival at 1, 3, and 5 years were similar between the DCD and DBD groups. These encouraging results with DCD-LT are probably due to the selection of DCD grafts and a clear definition of warm ischemia.