Strategies to Prevent Ischemic Cholangiopathy After Donation After Circulatory Death Donor Liver Transplantation.
1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
2Department of Pathology, Indiana University School of Medicine, Indianapolis, IN.
Meeting: 2016 American Transplant Congress
Abstract number: B261
Keywords: Donors, Ischemia, Liver transplantation, non-heart-beating, Outcome
Session Information
Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Donation after circulatory death (DCD) donor pool remains underutilized for liver transplantation (LT). We describe optimizing the “modifiable risk factors”, such as CIT, recipient WIT and the use of thrombolytic flush at the time of procurement, without limiting the donor age to improve outcomes.
Methods: From July 2011 (era 2), efforts were made to minimize CIT, operative time and recipient warm ischemia time (WIT) along with the use of tissue plasminogen activator (tPA) flush during procurements. 30 consecutive DCD LTs were performed prospectively with the use of these modifications. Outcomes were compared with 61 historic controls (era 1).
Results: Median CIT, native hepatectomy time (HT), recipient WIT were significantly shorter in the second era (Table). Donor and recipient characteristics are outlined in table 1. None of the patients in era 2 developed IC (0% vs. 18%, p=0.03). 1-year graft loss was numerically lower in era 2 (10% vs. 20%; p= 0.14). In a multivariate analysis, CIT was the only variable associated with development of ischemic cholangiopathy (IC) [OR 1.6,p=0.03].
Conclusion: Optimizing peri-transplant conditions such as shortening CIT, recipient WIT and use of thrombolytic donor flush may prevent IC and improve overall outcomes. These modifications may allow expansion of the donor pool.
| Era 1 (n=61) | Era 2 (n=30) | p | |
| Recipient Characteristics | |||
| Age | 54[23-71] | 60[33-70] | 0.01 |
| Female gender | 27(44%) | 2(7%) | 0.02 |
| MELD score | 15[7-27] | 23[15-40] | <0.001 |
| Donor Characteristics | |||
| Age | 38 [9-60] | 33 [9-52] | 0.14 |
| BMI | 25 [14-48] | 23 [17-40] | 0.39 |
| donor WIT | 29 [23-85] | 21 [10-36] | 0.01 |
| Flush (HTK:UW) | 11:51 | 0:30 | 0.01 |
| tPA pre flush | 0 | 30(100%) | <0.001 |
| Operative Characteristics | |||
| CIT | 6.4 [4.3-12] | 4.9[3.5-5.9] | <0.001 |
| Hepatectomy time | 81[48-207] | 70[42-120] | 0.02 |
| recipient WIT | 24[15-40] | 16[13-31] | <0.001 |
| Operative time | 221[141-561] | 200[152-368] | 0.49 |
| Outcomes | |||
| Early allograft dysfunction | 22(36%) | 7(23%) | 0.9 |
| Iscemic cholangiopathy | 11(18%) | 0 | 0.03 |
| Extrahepatic biliary stricture | 32(52%) | 5(17%) | 0.02 |
| 1-year graft loss | 14(23%) | 3(10%) | 0.14 |
| Death censored 1yr graft loss | 9(15%) | 0 | 0.02 |
CITATION INFORMATION: Kubal C, Mangus R, Fridell J, Ekser B, Rush N, Saxena R, Tector J. Strategies to Prevent Ischemic Cholangiopathy After Donation After Circulatory Death Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Kubal C, Mangus R, Fridell J, Ekser B, Rush N, Saxena R, Tector J. Strategies to Prevent Ischemic Cholangiopathy After Donation After Circulatory Death Donor Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/strategies-to-prevent-ischemic-cholangiopathy-after-donation-after-circulatory-death-donor-liver-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress