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Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters
Naeem Goussous1, Josue Alvarez-Casas1, Noor Dawany2
1Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Insights
Minimizing donor hepatectomy time and cold ischemic time in liver transplantation from circulatory death donors significantly reduced ischemic cholangiopathy incidence. This strategy may expand donor pool for liver transplants.
Area of Science:
- Hepatobiliary surgery
- Transplant immunology
- Organ preservation
Background:
- Liver transplantation from donation after circulatory death (DCD) has improving outcomes, but ischemic cholangiopathy (IC) remains a challenge.
- Measures to minimize donor hepatectomy time (DHT) and cold ischemic time (CIT) were implemented in 2014 to enhance DCD liver transplant (LT) results.
Purpose of the Study:
- To evaluate the impact of minimizing DHT and CIT on DCD LT outcomes, specifically the incidence of IC.
- To compare DCD LT outcomes before and after the implementation of reduced DHT and CIT protocols.
Main Methods:
- Retrospective review of 112 patients undergoing DCD LT between 2005 and 2017.
- Comparison of outcomes between a historic group (pre-2014) and a modern group (2014-2017).
Main Results:
- The modern group had significantly shorter DHT (14 vs. 21.5 min) and CIT (4.2 vs. 5.3 h) compared to the historic group.
- Ischemic cholangiopathy (IC) incidence was significantly lower in the modern group (6.1% vs. 23.3%).
- No significant differences in graft or patient survival were observed between the groups.
Conclusions:
- Minimizing DHT and CIT in DCD liver transplantation can decrease the incidence of IC in selected recipients.
- These optimized organ preservation strategies hold potential for expanding the DCD donor pool for liver transplantation.
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.
