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

Naeem Goussous, MD; Josue Alvarez-Casas, MD; Noor Dawany, PhD; Wen Xie, MD; Saad Malik, MD; Stephen H. Gray, MD; Rolf N. Barth, MD; John C. LaMattina, MD

doi:10.1097/TXD.0000000000001277

Transplantation Direct (Jan 2022)

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

Naeem Goussous, MD,
Josue Alvarez-Casas, MD,
Noor Dawany, PhD,
Wen Xie, MD,
Saad Malik, MD,
Stephen H. Gray, MD,
Rolf N. Barth, MD,
John C. LaMattina, MD

Affiliations

Naeem Goussous, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Josue Alvarez-Casas, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Noor Dawany, PhD: 2 Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA.
Wen Xie, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Saad Malik, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Stephen H. Gray, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Rolf N. Barth, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
John C. LaMattina, MD: 1 Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

DOI: https://doi.org/10.1097/TXD.0000000000001277
Journal volume & issue: Vol. 8, no. 1
p. e1277

Abstract

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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.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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