Increased Incidence of Non Anastomotic Biliary Strictures in Case of Donation after Circulatory Death Versus Donation after Brain Death Liver Transplantation but Equivalent Graft and Patient Survival

N. Meurisse, S. Vanden Bussche, I. Jochmans, V. Heedfeld, R. Aerts, W. Laleman, S. Van der Merwe, C. Verslype, D. Cassiman, W. Van Steenbergen, F. Nevens, J. Pirenne, D. Monbaliu

Abdominal Transplant Surgery Department, University Hospital Leuven, Leuven, Belgium
Hepatology Department, University Hospital Leuven, Leuven, Belgium

Meeting: 2013 American Transplant Congress

Abstract number: 447

Because of the concerns regarding short & long-term outcomes after Liver Transplantation (LTx) using Donation after Circulatory Death (DCD) compared to Donation after Brain Death (DBD) donors, we reviewed the results of DCD-LTx at our center. Between 2003 and 2010, 30 DCD-LTx and 385 DBD-LTx were performed. Demographics, LTx indications, post-LTx peak aspartate amino transaminase (AST peak), delayed graft function (DGF) (Olthoff criteria), biliary non-anastomotic strictures (NAS), early post-LTx kidney dysfunction (RIFLE criteria), re-transplantation rate and patient/graft survival were analyzed. Mean DCD donor warm ischemia (stop ventilation to cold perfusion) was 23+/-11’. Median cold ischemia was 6h54’ for DCD compared to 8h40’ for DBD-LTx; p=0.0001. Mean labMELD was similar for DCD and DBD-LTx (15 vs. 16; p=0.59). Median post-LTx AST peak was higher after DCD vs. DBD-LTx (1178 IU/L vs. 651 IU/L; p=0.005). DGF rate was similar between DCD and DBD-LTx (25 vs. 24%, p=0.8). The rate of NAS was higher after DCD vs. DBD-LTx (33% vs. 12%; p=0.001). Incidence of early post-LTx kidney dysfunction was not statistically different after DCD and DBD-LTx (37% vs. 23%, p=0.08). On the other hand, regardless the donor type, the AST peak – a surrogate of ischemia-reperfusion injury often used as an appropriate criterion for DGF evaluation – was associated with a higher rate of early post-LTX kidney dysfunction if greater than 2000 (28 vs. 10%, p=0.001) but not with NAS (12 vs. 15%, p=0.59). Re-transplantation rate within one year post-LTx was 3% after both DCD and DBD-LTx. The 1, 3, & 5-yr patient/graft survival were similar after DCD and DBD-LTx (93, 85, 85% vs. 88, 78 & 72%; p=0.3, and 90, 82, 82% vs. 85, 74 & 68%; p=0.5, respectively). Despite substantial ischemic injury, short& long-term patient/graft survival after DCD-LTx is comparable to DBD-LTx. Careful donor/recipient selection, rapid donor surgery and short ischemia times are key factors to optimize outcome after DCD-LTx. However, strategies to reduce ischemic injury and biliary complications remain warranted.

To cite this abstract in AMA style:

Meurisse N, Bussche SVanden, Jochmans I, Heedfeld V, Aerts R, Laleman W, Merwe SVander, Verslype C, Cassiman D, Steenbergen WVan, Nevens F, Pirenne J, Monbaliu D. Increased Incidence of Non Anastomotic Biliary Strictures in Case of Donation after Circulatory Death Versus Donation after Brain Death Liver Transplantation but Equivalent Graft and Patient Survival [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/increased-incidence-of-non-anastomotic-biliary-strictures-in-case-of-donation-after-circulatory-death-versus-donation-after-brain-death-liver-transplantation-but-equivalent-graft-and-patient-survival/. Accessed November 22, 2024.

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