Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Liver Transplantation (LT) from donation after circulatory death (DCD) is associated with increased non-anastomotic biliary strictures (NAS) and graft loss. Donor and recipient demographics, transplant and outcome data were compared between recipients with NAS (NAS+) and those without (NAS-) in a cohort of 61 consecutive DCD-LT (01/2003-12/2013). Risk factors for NAS occurring <1y after DCD-LT were identified in multivariate regression. Median (IQR) is given.
13/61 developed NAS. Incidence of NAS decreased over time (30% in 2003-2010, 15% in 2011-2013) in parallel with a decrease in cold ischemia time (CIT) [6.8h (5.5-8) in 2003-2010, 5.4h (4.75-6.4) in 2011-2013, p=0.002]. Donor and recipient age and gender, warm ischemia time [NAS+ 20min (15-29) vs NAS- 22min (16-28), p=ns], donor peak AST/ALT did not differ. NAS+ had a higher DRI [3.01 (2.86-3.49) vs 2.67 (2.37-3.05), p=0.031], longer CIT [7.3h (5.95-8.52) vs 5.6h (4.97-6.75), p=0.004] and anastomotic time [55min (46.5-60.5) vs 46min (42-52.5), p=0.038]. NAS occurred more frequently in grafts exposed to CIT>5h vs CIT<5h (26.5% vs 0%, p=0.054). Peak ALT post-LT was higher in NAS+ vs NAS- [1114IU/L (745-1566) vs 645IU/L (318-1087), p=0.019]. No difference in early allograft dysfunction (NAS+ 23.1% vs NAS- 20.8%, p=ns) or acute kidney injury was observed. The need for re-LT and endoscopic biliary intervention was higher in NAS+ vs NAS- (7.7% vs 0% and 84.6% vs 10.4% respectively, p<0.0001). One year censored graft and patient survival were similar between NAS+ and NAS- (84.6% vs 89.6%, 92.3% vs 91.7% respectively, p=ns). NAS did not influence the risk of death (HR:1, 95%CI:0.28-3.6) or graft loss (HR:1.62, 95%CI:0.57-4.6). CIT was the only independent risk factor of NAS (HR:1.42, 95%CI:1.06-1.92). Even with overall short CIT (5.78h, 5.13-7.13), the risk for NAS development in the 1st year post-transplant increases 1,42 times by every additional hour of CIT. In the absence of interventions that might directly prevent NAS, active efforts to maximally reduce CIT in DCD-LT are essential.
CITATION INFORMATION: Gilbo N, Jochmans I, Sainz M, Pirenne J, Monbaliu D. Reducing Non-Anastomotic Biliary Strictures After Donation After Circulatory Death Liver Transplantation, a Matter of Time? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Gilbo N, Jochmans I, Sainz M, Pirenne J, Monbaliu D. Reducing Non-Anastomotic Biliary Strictures After Donation After Circulatory Death Liver Transplantation, a Matter of Time? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/reducing-non-anastomotic-biliary-strictures-after-donation-after-circulatory-death-liver-transplantation-a-matter-of-time/. Accessed April 3, 2020.
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