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

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Fig. 1
Rate of survival free of ischemic cholangiopathy (IC) in patients who received liver grafts from donation after cardiocirculatory death donors, July 2006 to July 2016. All cases of IC occurred within the first 6 months after transplantation. Time to development of ischemic cholangiopathy, d % survival

Table 1

Study population characteristics

Characteristic	No. (%) of patients^*		p value
Characteristic	Early era n = 32	Late era n = 38	p value
Donors
Demographic
Age, yr, median (IQR)	44 (18–62)	38 (12–59)	0.1
Male sex	16 (50)	28 (74)	0.04
Height, cm, median (IQR)	169 (150–193)	175 (152–188)	0.1
Weight, kg, mean ± SD	76 ± 5.6	75 ± 14.6	0.49
Body mass index, median (IQR)	25 (17–46)	24 (17–35)	0.2
Donor Risk Index score, median (IQR)	2.46 (1.7–3.2)	2.1 (1.6–3.4)	0.02
Location			0.04
Local	15 (47)	27 (71)
Regional	17 (53)	11 (29)
Cause of death			0.049
Trauma	13 (41)	15 (39)
Anoxia	6 (19)	16 (42)
Cerebrovascular accident	13 (41)	7 (18)
Procurement times
Warm ischemia time, min, median (IQR)	27 (18–121)	24 (16–48)	0.049
Cut–cannulation–flush, min, median (IQR)	6 (2–12)	4 (2–8)	0.02
Skin cut to liver out, min, median (IQR)	56 (21–97)	52 (28–121)	0.2
Cold ischemia time, h, median (IQR)	5.56 (4.45–6.45)	5.10 (4.46–6.37)	0.4
Recipients
Demographic
Age, yr, median (IQR)	54 (26–69)	57 (36–66)	0.3
Male sex	26 (81)	26 (68)	0.2
MELD score, median (IQR)	15 (8–40)	17 (3–35)	0.7
Diagnosis			0.003
Hepatitis C	12 (38)	4 (10)
Hepatocellular carcinoma	8 (25)	15 (39)
Alcoholic liver disease	5 (16)	2 (5)
Autoimmune	3 (9)	0 (0)
Nonalcoholic steatohepatitis	0 (0)	5 (13)
Primary biliary cirrhosis	0 (0)	3 (8)
Primary sclerosing cholangitis	0 (0)	3 (8)
Other	4 (12)	6 (16)

IQR = interquartile range; MELD = Model for End-Stage Liver Disease; SD = standard deviation.
↵* Except where noted otherwise.

Table 2

Transplantation outcomes

Variable	No. (%) of recipients^*		p value
Variable	Early era n = 32	Late era n = 38	p value
Biliary complications	12 (38)	7 (18)	0.07
Ischemic cholangiopathy	8 (25)	1 (3)	0.005
Anastomotic stricture	3 (9)	4 (10)	0.9
Bile leak	0 (0)	1 (3)	1.0
Choledocholithiasis	1 (3)	1 (3)	1.0
Management of biliary complications
ERCP	13 (41)	6 (16)	0.02
Total no. of ERCP procedures (range per patient)	52 (1–16)	7 (1–2)	0.008
No. of patients with stent	9 (28)	4 (10)	0.05
Total no. of stents (range per patient)	20 (1–4)	6 (1–2)	0.05
Length of stay, d, median (IQR)	12 (8–161)	13 (7–115)	0.9
Graft function
Primary nonfunction	2 (6)	2 (5)	0.9
Graft failure	9 (28)	3 (8)	0.02
Survival
Graft survival, d, mean ± SD	2778 ± 266	1477 ± 131	0.5
90 d	29 (91)	35 (92)
1 yr	27 (84)	31 (82)	0.8
3 yr	24 (75)	29 (76)
Retransplantation	3 (9)	1 (3)	0.2
Patient survival, d, mean ± SD	3016 ± 251	1518 ± 158	0.3
90 d	29 (91)	36 (95)
1 yr	28 (88)	31 (82)	0.5
3 yr	25 (78)	29 (76)
Death	8 (25)	9 (24)	1.0