Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience

• Published in: Canadian Journal of Surgery 2019-02, Vol.62 (1), p.44-51
• Main Authors: Tun-Abraham, Mauro Enrique, Wanis, Kerollos, Garcia-Ochoa, Carlos, Sela, Nathalie, Sharma, Hemant, Al Hasan, Ibrahim, Quan, Douglas, Al-Judaibi, Bandar, Levstik, Mark, Hernandez-Alejandro, Roberto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; Bile Duct Diseases - etiology; Bile Duct Diseases - prevention & control; Brain death; Canada; Computer industry; Databases, Factual; Death; End Stage Liver Disease - surgery; Evaluation; Female; Gifts; Graft Survival; Heart; Humans; Ischemia; Ischemia - etiology; Ischemia - prevention & control; Jewelry; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Male; Middle Aged; Mortality; Organ transplant recipients; Organ transplantation; Patient Selection; Patients; Purchasing; Retrospective Studies; Statistical analysis; Studies; Surgery; Survival Analysis; Systematic review; Time Factors; Tissue and Organ Harvesting - standards; Tissue and Organ Procurement - standards; Tissue donation; Tissue Donors; Transplant Recipients; Transplants & implants; Treatment Outcome; Warm Ischemia - standards
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.012017

Outcomes in liver transplantation with organs obtained via donation after cardiocirculatory death (DCD) have been suboptimal compared to donation after brain death, attributed mainly to the high incidence of ischemic cholangiopathy (IC). We evaluated the effect of a 10-year learning curve on IC rates among DCD liver graft recipients at a single centre. We analyzed all DCD liver transplantation procedures from July 2006 to July 2016. Patients were grouped into early (July 2006 to June 2011) and late (July 2011 to July 2016) eras. Those with less than 6 months of follow-up were excluded. Primary outcomes were IC incidence and IC-free survival rate. Among the 73 DCD liver transplantation procedures performed, 70 recipients fulfilled the selection criteria, 32 in the early era and 38 in the late era. Biliary complications were diagnosed in 19 recipients (27%). Ischemic cholangiopathy was observed in 8 patients (25%) in the early era and 1 patient (3%) in the late era (p = 0.005). The IC-free survival rate was higher in the late era than the early era (98% v. 79%, p = 0.01). The warm ischemia time (27 v. 24 min, p = 0.049) and functional warm ischemia time (21 v. 17 min, p = 0.002) were significantly lower in the late era than the early era. We found a significant reduction in IC rates and improvement in ICfree survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.