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. 2021 Dec 23;8(1):e1277.
doi: 10.1097/TXD.0000000000001277. eCollection 2022 Jan.

Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters

Naeem Goussous  1 , Josue Alvarez-Casas  1 , Noor Dawany  2 , Wen Xie  1 , Saad Malik  1 , Stephen H Gray  1 , Rolf N Barth  1 , John C LaMattina  1
Affiliations

Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters

Naeem Goussous et al. Transplant Direct. .

Abstract

Background: Outcomes of liver transplantation (LT) from donation after circulatory death (DCD) have been improving; however, ischemic cholangiopathy (IC) continues to be a problem. In 2014, measures to minimize donor hepatectomy time (DHT) and cold ischemic time (CIT) have been adopted to improve DCD LT outcomes.

Methods: Retrospective review of all patients who underwent DCD LT between 2005 and 2017 was performed. We compared outcomes of patients who were transplanted before 2014 (historic group) with those who were transplanted between 2014 and 2017 (modern group).

Results: We identified 112 patients; 44 were in the historic group and 68 in the modern group. Donors in the historic group were younger (26.5 versus 33, P = 0.007) and had a lower body mass index (26.2 versus 28.2, P = 0.007). DHT (min) and CIT (h) were significantly longer in the historic group (21.5 versus 14, P < 0.001 and 5.3 versus 4.2, P < 0.001, respectively). Fourteen patients (12.5%) developed IC, with a significantly higher incidence in the historic group (23.3% versus 6.1%, P = 0.02). There was no difference in graft and patient survival between both groups.

Conclusion: In appropriately selected recipients, minimization of DHT and CIT may decrease the incidence of IC. These changes can potentially expand the DCD donor pool.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Annual volume of DCD liver transplantation in our center. DCD, donation after circulatory death.
FIGURE 2.
FIGURE 2.
Kaplan-Meier curve for liver and overall survival.
FIGURE 3.
FIGURE 3.
Kaplan-Meier curve for liver graft survival for historic and modern cohorts.
FIGURE 4.
FIGURE 4.
Kaplan-Meier curve for overall survival for historic and modern cohorts.
See this image and copyright information in PMC

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