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Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta-analysis
Colleen L Jay1, Vadim Lyuksemburg, Daniela P Ladner
1Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Insights
Donation after cardiac death liver transplantation is associated with significantly higher risks of biliary complications, including ischemic cholangiopathy, and worse patient outcomes compared to donation after brain death. These findings highlight critical considerations for graft utilization and patient care.
Area of Science:
- Hepatology
- Transplantation Surgery
- Gastroenterology
Background:
- Biliary complications pose significant health and economic challenges in liver transplantation.
- Understanding these risks is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the risks of biliary complications, particularly ischemic cholangiopathy (IC), after liver transplantation from donation after cardiac death (DCD) versus donation after brain death (DBD) donors.
- To enhance the understanding of outcomes associated with DCD liver transplantation.
Main Methods:
- A meta-analysis was performed using data from MEDLINE, EMBASE, and Cochrane Library databases.
- Eleven retrospective cohort studies involving 489 DCD and 4455 DBD liver transplant recipients were included.
- Odds ratios (OR) and 95% confidence intervals (CI) were calculated using random effects models.
Main Results:
- Donation after cardiac death recipients had a 2.4-fold increased odds of biliary complications and a 10.8-fold increased odds of IC.
- Ischemic cholangiopathy occurred in 16% of DCD recipients versus 3% of DBD recipients.
- DCD recipients also showed higher odds of 1-year mortality and graft failure.
Conclusions:
- Donation after cardiac death liver transplantation is linked to inferior outcomes, including higher rates of biliary complications and IC.
- Increased mortality and graft failure rates are observed in DCD recipients.
- The elevated risks and poor outcomes necessitate careful consideration of DCD graft utilization.
Objective:
To conduct a meta-analysis to enhance understanding of the risks of biliary complications, particularly ischemic cholangiopathy (IC), after donation after cardiac death (DCD) compared with donation after brain death (DBD) liver transplantation.
Background:
Biliary complications after liver transplantation have profound health and economic implications which merit further investigation.
Methods:
The MEDLINE (1950–2009), EMBASE, and Cochrane Library databases were searched and supplemented by review of conference proceedings and publication bibliographies. All original single institution studies reporting outcomes for DCD and DBD liver transplant recipients were considered. Odds ratios (OR) and 95% confidence intervals (CI) based on random effects models were calculated.
Results:
Eleven publications, all retrospective cohort studies, involving 489 DCD and 4455 DBD recipients, were included. Donation after cardiac death recipients had a 2.4 times increased odds of biliary complications (95% CI= 1.8–3.4) and a 10.8 times increased odds of IC (95% CI = 4.8–24.2).Ischemic cholangiopathy was present in 16% of DCD compared with 3% of DBD recipients. Donation after cardiac death recipients also experienced higher odds of 1-year patient mortality (OR = 1.6, 95% CI = 1.04–2.5) and graft failure (OR = 2.1, 95% CI = 1.5–2.8).
Conclusions:
Donation after cardiac death liver transplantation is marred by inferior outcomes including higher rates of biliary complications and IC as well as increased mortality and graft failure. Despite current federal mandates to increase DCD donation, these serious complications translate into poor outcomes for individuals and increased healthcare costs. These risks should be considered in decisions regarding the utilization of these grafts.
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