Biliary Complications After Liver Transplantation From Uncontrolled Donors After Circulatory Death: Incidence, Management, and Outcome
Loading...
Full text at PDC
Publication date
2020
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
The American Association for the Study of Liver Diseases
Citation
Biliary Complications After Liver Transplantation From Uncontrolled Donors After Circulatory Death: Incidence, Management, and Outcome. Jiménez-Romero C, Manrique A, García-Conde M, Nutu A, Calvo J, Caso Ó, Marcacuzco A, García-Sesma Á, Álvaro E, Villar R, Aguado JM, Conde M, Justo I. Liver Transpl. 2020 Jan;26(1):80-91
Abstract
The utilization of livers from donation after uncontrolled circulatory death (uDCD) increases the availability of liver grafts,
but it is associated with a higher incidence of biliary complications (BCs) and lower graft survival than those organs donated
after brain death. From January 2006 to December 2016, we performed 75 orthotopic liver transplantations (OLTs) using
uDCD livers. To investigate the relationship of BCs with the use of uDCD OLT, we compared patients who developed BCs
(23 patients) with those who did not (non-BC group, 43 patients) after excluding cases of hepatic artery thrombosis (a known
cause of BC) and primary nonfunction. The groups had similar uDCD donor maintenance, donor and recipient characteristics,
and perioperative morbidity/mortality rates, but we observed a higher rate of hepatocellular carcinoma and hepatitis
C virus in the non-BC group. Percutaneous transhepatic biliary dilation, endoscopic retrograde cholangiopancreatography
dilation, Roux-en-Y hepaticojejunostomy (HJ), a T-tube, and retransplantation were used for BC management. In the BC
group, 1-, 3-, and 5-year patient survival rates were 91.3%, 69.6%, and 65.2%, respectively, versus 77.8%, 72.9%, and 72.9%,
respectively, in the non-BC group (P = 0.89). However, 1-, 3-, and 5-year graft survival rates were 78.3%, 60.9%, and 56.5%,
respectively, in the BC group versus 77.8%, 72.9%, and 72.9%, respectively, in the non-BC group (P = 0.38). Multivariate
analysis did not indicate independent risk factors for BC development. In conclusion, patient and graft survival rates were
generally lower in patients who developed BCs but not significantly so. These complications were managed in the majority of
patients through radiological dilation, endoscopic dilation, or Roux-en-Y HJ. Retransplantation is necessary in rare cases after
the failure of biliary dilation or surgical procedures.