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Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multicenter IDOL Consortium
David S Goldberg1, Seth J Karp, Maureen E McCauley
11 Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA. 2 Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 4 Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, PA. 5 Division of Transplantation, Massachusetts General Hospital, Boston, MA. 6 Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL. 7 Division of Transplantation Surgery, Mayo Clinic College of Medicine, Rochester, MN. 8 Division of GI and Hepatology Surgery, Mayo Clinic College of Medicine, Rochester, MN. 9 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. 10 Section of Abdominal Organ Transplantation, Ochsner Clinic, Jefferson, LA. 11 Department of Medicine, University of Kansas Medical Center, Kansas City, KS. 12 Department of Surgery, University of Kansas Medical Center, Kansas City, KS. 13 Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 14 Veterans Administration Surgical Services, William S. Middleton Memorial Hospital, Madison, WI. 15 University of Wisconsin School of Medicine and Public Health. 16 Division of Transplantation, University of Rochester, Rochester, NY. 17 Division of Transplantation, Western University, Canada. 18 Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA.
Background:
In the United States, 5% of adult liver transplant recipients receive a graft donation after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes.
Methods:
Retrospective deidentified data collected between 2005 and 2013 were entered electronically by 10 centers via a Research Electronic Data Capture database. Our primary outcome was development of intrahepatic biliary strictures consistent with IC.
Results:
Within 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intrahepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (P = 0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (vs duct-to-duct) (odds ratio, 3.06; 95% confidence interval, 1.52-6.16; P = 0.002). Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (odds ratio for IC, 3.36; 95% confidence interval, 1.95-5.79).
Conclusions:
This first report of the large combined experience with DCDD from the Improving DCDD Outcomes in Liver Transplant consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies.
