Donation after Circulatory Death Donor Liver Transplantation without Ischemic Cholangiopathy: Is It Time to Expand DCD Liver Donor Pool?
1Transplant Surgery, Indiana University, Indianapolis
2Division of General Surgery, IRCCS Policlinico San Matteo Foundation, University of Pavia, Lombardy, Italy.
Meeting: 2018 American Transplant Congress
Abstract number: 471
Keywords: Donors, Graft failure, Liver transplantation, non-heart-beating
Session Information
Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues - 2
Session Type: Concurrent Session
Date: Tuesday, June 5, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 6B
Background: To prevent ischemic cholangiopathy (IC) after liver transplantation (LT), a protocol optimizing peri-operative conditions along with thrombolytic (tissue plasminogen activator) donor flush during DCD procurements was introduced at our center in July 2011.
Methods: 57 consecutive DCD LTs were performed using this protocol (Era II). Outcomes were compared with 61 historic controls (Era I) and 1619 donation after brain death (DBD) donor LT. Expanded criteria donor (ECD) DCD livers were defined as those with one of the following factors: 1) donor age > 55 years, 2) donor BMI > 35, 4) donor functional warm ischemia time (fWIT) > 30 minutes, and 5) donor liver macrosteatosis >30%.
Results: Cold ischemia time (CIT), recipient hepatectomy and anastomoses times were significantly shorter in era II (p<0.001, 0.001 &<0.001 respectively). In era II, there were fewer biliary complications and none of the patients developed IC, compared to 18% in era I (p<0.05) (Table 1). One year DCD LT graft survival for recipients in era II was significantly higher than that of recipients in era I (93% vs. 79%, p=0.01) which was comparable to deceased donor (DBD) LT recipients (89%, p=0.22). The use of ECD DCD livers was comparable in the two eras (30% in era I vs. 23% in era II, p=0.35), and graft loss was significantly higher (53% vs. 0%, p=0.004) in era I for ECD DCD livers. Number of DCD LT performed at our center gradually increased after institution of the optimization protocol to account for 12% of center's LT volume.
Conclusions: Shorter ischemic times along with thrombolytic donor flush prevented IC, and improved survival outcomes after DCD LT. The improvement in clinical outcomes was associated regrowth of DCD LT program.
| DCD Era I | DCD Era II | p | |
| Biliary anastomotic strictures | 45% | 25% | 0.02 |
| Ischemic cholangiopathy | 18% | 0% | 0.01 |
| Hepatic artery thrombosis | 3% | 0% | 0.17 |
| Re-transplantation | 3% | 0% | 0.18 |
| Length of hospital stay | 13 [0-80] | 15 [7-39] | 0.85 |
| Early allograft dysfunction | 47% | 51% | 0.66 |
| 30-day graft loss | 5% | 0% | 0.25 |
| 1-year graft survival | 79% | 93% | 0.02 |
CITATION INFORMATION: Kubal C., Mihaylov P., Ekser B., Cabrales A., Fridell J., Mangus R. Donation after Circulatory Death Donor Liver Transplantation without Ischemic Cholangiopathy: Is It Time to Expand DCD Liver Donor Pool? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kubal C, Mihaylov P, Ekser B, Cabrales A, Fridell J, Mangus R. Donation after Circulatory Death Donor Liver Transplantation without Ischemic Cholangiopathy: Is It Time to Expand DCD Liver Donor Pool? [abstract]. https://atcmeetingabstracts.com/abstract/donation-after-circulatory-death-donor-liver-transplantation-without-ischemic-cholangiopathy-is-it-time-to-expand-dcd-liver-donor-pool/. Accessed December 3, 2024.« Back to 2018 American Transplant Congress