RT Journal Article
SR Electronic
T1 Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 44
OP 51
DO 10.1503/cjs.012017
VO 62
IS 1
A1 Mauro Enrique Tun-Abraham
A1 Kerollos N. Wanis
A1 Carlos Garcia-Ochoa
A1 Nathalie Sela
A1 Hemant Sharma
A1 Ibrahim Al Hasan
A1 Douglas Quan
A1 Bandar Al-Judaibi
A1 Mark Levstik
A1 Roberto Hernandez-Alejandro
YR 2019
UL http://canjsurg.ca/content/62/1/44.abstract
AB Background: 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.Methods: 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.Results: 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.Conclusion: We found a significant reduction in IC rates and improvement in IC-free survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.