Patient and Graft Survival: Biliary Complications after Liver Transplantation

Abstract Introduction Biliary leaks and anastomotic strictures are common early biliary complications (EBC) following liver transplantation. However, their impact on outcomes remains controversial and poorly described. Method The NHS registry on adult liver transplantation between 2006 and 2017 was retrospectively reviewed (n=8304). Multiple imputations were performed to account for missing data. Adjusted regression models were used to assess predictors of EBC, and their impact on outcomes. 35 potential variables were included, and backwards stepwise selection enabled unbiased selection of variables for inclusion in final models. Result EBC occurred in 9.6% of patients. Adjusted cox regression revealed that EBCs have a significant and independent impact on graft survival (Leak HR=1.325; P=0.021, Stricture HR=1.514; P=0.002, Leak plus stricture HR=1.533; P=0.034) and patient survival (Leak HR=1.218; P=0.131, Stricture HR=1.578; P<0.001, Leak plus stricture HR=1.507; P=0.044). Patients with EBC had longer median hospital stay (23 versus 15 days; P<0.001) and increased chance for readmission within the first year (56% versus 32%; P<0.001). On adjusted logistic regression the following were identified as independent risk factors for development of EBC: donation following circulatory death (OR=1.280; P=0.009), accessory hepatic artery (OR=1.324; P=0.005), vascular anastomosis time in minutes (OR=1.005; P=0.032) and ethnicity ‘other’ (OR=1.838; P=0.011). Conclusion EBCs prolong hospital stay, increase readmission rates and are independent risk factors for diminished graft survival and increased mortality in liver transplantation. We have identified factors that increase the likelihood of EBC occurrence; further research into interventions to prevent EBCs in these at-risk groups is vital to improve liver transplantation outcomes. Take-home message Using a large registry database we have shown that early anastomotic biliary complications are independent risk factors for decreased graft survival and increased mortality after liver transplantation. Research into interventions to prevent biliary complications in high risk groups are essential to improve liver transplant outcomes.

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P42 Predictors of patient and graft survival following pediatric liver transplantation: Long-term analysis of more than 300 cases from single centre

10.1136/flgastro-2021-bspghan.51 ◽

2021 ◽

Author(s):

Amr Alnagar ◽

Khaled Daradka ◽

Eirini Kyrana ◽

Marumbo Methga ◽

Karthikeyan Palaniswamy ◽

...

Keyword(s):

Liver Transplantation ◽

Graft Survival ◽

Pediatric Liver Transplantation ◽

Single Centre ◽

Pediatric Liver ◽

Term Analysis ◽

Patient And Graft Survival

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Biliary complications adversely affect patient and graft survival after liver retransplantation

Liver Transplantation ◽

10.1002/lt.23696 ◽

2013 ◽

Vol 19 (9) ◽

pp. 965-972 ◽

Cited By ~ 21

Author(s):

C. Kristian Enestvedt ◽

Saloni Malik ◽

Peter P. Reese ◽

Alexander Maskin ◽

Peter S. Yoo ◽

...

Keyword(s):

Graft Survival ◽

Biliary Complications ◽

Liver Retransplantation ◽

Patient And Graft Survival

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Donation after Circulatory Death: Potential Mechanisms of Injury and Preventative Strategies

Seminars in Liver Disease ◽

10.1055/s-0040-1709487 ◽

2020 ◽

Vol 40 (03) ◽

pp. 256-263

Author(s):

Kristopher P. Croome

Keyword(s):

Liver Transplantation ◽

Clinical Practice ◽

Learning Curve ◽

Graft Survival ◽

Biliary Complications ◽

Donation After Circulatory Death ◽

Concise Review ◽

Number Of Patients ◽

Circulatory Death

AbstractDonation after circulatory death (DCD) donors represent a potential means to help address the disparity between the number of patients awaiting liver transplantation (LT) and the availability of donor livers. While initial enthusiasm for DCD LT was high in the early 2000s, early reports of high rates of biliary complications and inferior graft survival resulted in reluctance among many transplant centers to use DCD liver grafts. As with all innovations in transplant practice, there is undoubtedly a learning curve associated with the optimal utilization of liver grafts from DCD donors. More contemporary data has demonstrated that results with DCD LT are improving and the number of DCD LT performed annually has been steadily increasing. In this concise review, potential mechanisms of injury for DCD livers are discussed along with strategies that have been employed in clinical practice to improve DCD LT outcomes.

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Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

Digestive Disease Interventions ◽

10.1055/s-0040-1713369 ◽

2020 ◽

Vol 04 (02) ◽

pp. 223-234

Author(s):

Danielle Fritze ◽

Amandeep Singh ◽

Eric Lawitz ◽

Kris V. Kowdley ◽

Glenn Halff ◽

...

Keyword(s):

United States ◽

Liver Transplantation ◽

Graft Survival ◽

Nonalcoholic Steatohepatitis ◽

Multivariable Analysis ◽

Deceased Donor ◽

The United States ◽

Hispanic Males ◽

Patient And Graft Survival ◽

United Network

Abstract Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the most common indications for liver transplantation (LT) in the United States. A subset of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study characterizes patients with BASH requiring LT and assesses changes in the prevalence of BASH as an indication for LT. Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18 years of age who received their first deceased donor LT from 2002 to 2016 for ALD, NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared between groups. Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779 had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002 to 5% in 2016. Compared with patients with NASH, those with BASH were significantly more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic (22.2 vs. 13.6%) (p < 0.001 for all). While indication for transplant was not significantly associated with transplant outcomes on multivariable analysis, patient and graft survival curves do differ significantly by indication for transplant, with worse outcomes for patients with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046). Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing prevalence of ALD and NASH in the United States.

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