Donor Hepatectomy Time in Donation after Circulatory Death Donors is an Independent Risk Factor for the Development of Biliary Strictures and Early Graft Loss after Transplantation

O. van Leeuwen,¹ M. van Reeven,² M. Fujiyoshi,¹ V. de Meijer,¹ R. de Kleine,¹ M. de Boer,¹ J. de Jonge,² J. Ijzermans,² W. Polak,² R. Porte.¹

¹Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
²Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands.

Meeting: 2018 American Transplant Congress

Abstract number: A283

Keywords: Donation, Donors, Liver transplantation, non-heart-beating, Warm ischemia

Session Information

Session Name: Poster Session A: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

Introduction: Liver transplantation (LT) from donors after circulatory death (DCD) is associated with an increased risk of non-anastomotic biliary strictures (NAS) and early graft loss (EGL). After in situ cold flush in the donor, donor livers continue to suffer warm ischemia as the liver temperature stays between 15-20^[deg]C until stored in a box with ice. The aim of this study was to determine whether duration of donor hepatectomy time is associated with an increased risk of NAS and EGL after DCD LT.

Methods: A multicenter retrospective study was performed including all adult patients who underwent DCD LT's between 2004-2017. Baseline donor and recipient characteristics and data on post-transplant outcomes were collected and analyzed. Donor hepatectomy time was defined as time from in situ cold flush until end of hepatectomy, NAS as bile duct stenosis within two years after LT at any location in the biliary tree other than the anastomosis, EGL as graft loss within 3 months, donor warm ischemia time (WIT) as time from cardiac arrest until start of cold flush. Continuous data are expressed as median (IQR).

Results: Of 270 DCD LT's, 32 patients were excluded because of incomplete donor data. Donor hepatectomy time was 62 (49-76) min with significant differences among procurement teams. Overall rate of NAS was 22.7% and EGL occurred in 13.4%. Using univariate analysis, donor WIT, donor hepatectomy time and donor age were identified as significant risk factors for NAS and EGL. After multivariate logistic regression analysis donor hepatectomy time >90 min (OR 3,17; 95% CI, 1,37-7,33; p=0.007) and donor age >40 years (OR 2,24; 95% CI, 1,17-4,29; p=0.015) were identified as significant independent risk factors for the development of NAS and/or EGL.

Conclusion: Donor hepatectomy time is an independent risk factor for the development of NAS and EGL after DCD LT. Livers continue to suffer relatively warm ischemic injury during donor hepatectomy despite cold flush out, and this time period should be kept as short as possible, especially in DCD donors.

CITATION INFORMATION: van Leeuwen O., van Reeven M., Fujiyoshi M., de Meijer V., de Kleine R., de Boer M., de Jonge J., Ijzermans J., Polak W., Porte R. Donor Hepatectomy Time in Donation after Circulatory Death Donors is an Independent Risk Factor for the Development of Biliary Strictures and Early Graft Loss after Transplantation Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Leeuwen Ovan, Reeven Mvan, Fujiyoshi M, Meijer Vde, Kleine Rde, Boer Mde, Jonge Jde, Ijzermans J, Polak W, Porte R. Donor Hepatectomy Time in Donation after Circulatory Death Donors is an Independent Risk Factor for the Development of Biliary Strictures and Early Graft Loss after Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/donor-hepatectomy-time-in-donation-after-circulatory-death-donors-is-an-independent-risk-factor-for-the-development-of-biliary-strictures-and-early-graft-loss-after-transplantation/. Accessed May 6, 2025.

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