Biliary complications and outcomes of liver transplantation from donors after cardiac death

Anurag Maheshwari, Warren Maley, Zhiping Li, Paul J. Thuluvath

Research output: Contribution to journalArticle

Abstract

Biliary complications after liver transplantation (LT) using organs retrieved from donors after cardiac death are not well characterized. The aim of this study was to evaluate the severity of biliary complications and outcomes after donation after cardiac death liver transplantation (DCD-LT). A retrospective evaluation of 20 DCD-LTs from 1997-2006 was performed. The recipient age was 53 ± 8.7, and the donor age was 35 ± 11 years. The warm ischemia time, cold ischemia time, peak alanine aminotransferase level, and peak aspartate aminotransferase level were 33 ± 12 minutes, 8.7 ± 2.7 hours, 1757 ± 1477 U/L, and 4020 ± 3693 U/L, respectively. The bilirubin and alkaline phosphatase levels at hospital discharge after LT were 3.2 ± 5.4 mg/dL and 248 ± 200 U/L, respectively. During a median follow-up of 7.5 months (range: 1-73), 5 patients (25%; 1 death after re-LT) died (3 from sepsis, 1 from recurrent hepatocellular carcinoma at 4 months, and 1 from a cardiac event at 46 months), and additionally, 4 patients (20%) required re-LT (1 because of hepatic artery thrombosis, 1 because of primary graft nonfunction, and 2 because of biliary strictures). Twelve (60%) developed biliary complications, and of these, 11 (55%) had serious biliary complications. The biliary complications were as follows: a major bile leak for 2 patients (10%; both eventually underwent retransplantation), anastomotic strictures for 5 patients (25%), hilar strictures for 7 patients (35%), extrahepatic donor duct strictures for 9 patients (45%), intrahepatic strictures for 10 patients (50%), stones for 1 patients (5%), casts for 7 patients (35%), and debris for 2 patients (10%). More than 1 biliary complication was seen in most patients, and these were unpredictable and required multiple diagnostic or therapeutic procedures. Serious biliary complications are common after DCD-LT, and research should focus on identifying donor and recipient factors that predict and prevent serious biliary complications.

Original languageEnglish (US)
Pages (from-to)1645-1653
Number of pages9
JournalLiver Transplantation
Volume13
Issue number12
DOIs
StatePublished - Dec 2007

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Liver Transplantation
Tissue Donors
Pathologic Constriction
Cold Ischemia
Warm Ischemia
Hepatic Artery
Aspartate Aminotransferases
Alanine Transaminase
Bilirubin
Bile
Alkaline Phosphatase
Hepatocellular Carcinoma
Sepsis
Thrombosis
Transplants

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Biliary complications and outcomes of liver transplantation from donors after cardiac death. / Maheshwari, Anurag; Maley, Warren; Li, Zhiping; Thuluvath, Paul J.

In: Liver Transplantation, Vol. 13, No. 12, 12.2007, p. 1645-1653.

Research output: Contribution to journalArticle

Maheshwari, Anurag ; Maley, Warren ; Li, Zhiping ; Thuluvath, Paul J. / Biliary complications and outcomes of liver transplantation from donors after cardiac death. In: Liver Transplantation. 2007 ; Vol. 13, No. 12. pp. 1645-1653.
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abstract = "Biliary complications after liver transplantation (LT) using organs retrieved from donors after cardiac death are not well characterized. The aim of this study was to evaluate the severity of biliary complications and outcomes after donation after cardiac death liver transplantation (DCD-LT). A retrospective evaluation of 20 DCD-LTs from 1997-2006 was performed. The recipient age was 53 ± 8.7, and the donor age was 35 ± 11 years. The warm ischemia time, cold ischemia time, peak alanine aminotransferase level, and peak aspartate aminotransferase level were 33 ± 12 minutes, 8.7 ± 2.7 hours, 1757 ± 1477 U/L, and 4020 ± 3693 U/L, respectively. The bilirubin and alkaline phosphatase levels at hospital discharge after LT were 3.2 ± 5.4 mg/dL and 248 ± 200 U/L, respectively. During a median follow-up of 7.5 months (range: 1-73), 5 patients (25{\%}; 1 death after re-LT) died (3 from sepsis, 1 from recurrent hepatocellular carcinoma at 4 months, and 1 from a cardiac event at 46 months), and additionally, 4 patients (20{\%}) required re-LT (1 because of hepatic artery thrombosis, 1 because of primary graft nonfunction, and 2 because of biliary strictures). Twelve (60{\%}) developed biliary complications, and of these, 11 (55{\%}) had serious biliary complications. The biliary complications were as follows: a major bile leak for 2 patients (10{\%}; both eventually underwent retransplantation), anastomotic strictures for 5 patients (25{\%}), hilar strictures for 7 patients (35{\%}), extrahepatic donor duct strictures for 9 patients (45{\%}), intrahepatic strictures for 10 patients (50{\%}), stones for 1 patients (5{\%}), casts for 7 patients (35{\%}), and debris for 2 patients (10{\%}). More than 1 biliary complication was seen in most patients, and these were unpredictable and required multiple diagnostic or therapeutic procedures. Serious biliary complications are common after DCD-LT, and research should focus on identifying donor and recipient factors that predict and prevent serious biliary complications.",
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