Predictors of Biliary Strictures After Liver Transplantation Among Recipients of DCD (Donation After Cardiac Death) Grafts

• Published in: Digestive diseases and sciences 2019-07, Vol.64 (7), p.2024-2030
• Main Authors: Kohli, Divyanshoo R., Harrison, M. Edwyn, Adike, Abimbola O., El Kurdi, Bara, Fukami, Norio, Faigel, Douglas O., Pannala, Rahul, Moss, Adyr A., Aqel, Bashar A.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Bile; Bilirubin; Bilirubin - blood; Biochemistry; Biomarkers - blood; Blood & organ donations; Brain death; Cause of Death; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis - blood; Cholestasis - diagnostic imaging; Cholestasis - etiology; Cholestasis - therapy; Endoscopy; Female; Gastroenterology; Heart; Heart Diseases - mortality; Hepatology; Humans; International Normalized Ratio; Liver; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver transplants; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Patients; Retrospective Studies; Risk Factors; Systematic review; Time Factors; Tissue Donors; Transplant Surgery; Transplantation of organs, tissues, etc; Transplants & implants; Treatment Outcome
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-018-5438-0

Introduction Biliary strictures are a common complication among donation after cardiac death (DCD) liver transplantation (LT) recipients and may require multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. We evaluated the risk factors associated with development of biliary strictures in DCD LT recipients. Methods DCD LT recipients who underwent transplantation from 2012 to 2017 were divided into 2 groups: (a) those with anastomotic or non-anastomotic biliary strictures who required ERCP (“stricture group”) and (b) those who did not require ERCP or had cholangiograms without evidence of biliary strictures (“non-stricture group”). Clinical data, cholangiograms and laboratory values at day 0 and day 7 after LT were compared between the two groups. Results Forty-nine of the 100 DCD LT recipients underwent ERCP. Thirty-four of these 49 LT recipients had evidence of anastomotic or non-anastomotic biliary strictures (stricture group), while the remaining 66 LT recipients comprised the non-stricture group. Donor age was significantly higher in stricture group compared to non-stricture group (49.2 ± 1.8 vs 42.8 ± 1.57 years, respectively; p  = 0.01). The stricture group had a significantly higher total bilirubin at day 0 (3.5 ± 0.37 vs 2.6 ± 0.21 mg/dL; p  = 0.02) and INR at day 7 (1.24 ± 0.06 vs 1.13 ± 0.01; p  = 0.048) compared to the non-stricture group. Multi-variate analysis demonstrated significant association between biliary strictures and total bilirubin at day 0 of LT and age of donor. Conclusion Biliary strictures occur frequently in DCD LT recipients and may be associated with older age of donor. Hyperbilirubinemia immediately after transplant and higher INR in the first 7 days after transplant may predict subsequent development of biliary strictures.