Differential Rates of Ischemic Cholangiopathy and Graft Survival Associated With Induction Therapy in DCD 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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The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: The untold story

Surgery ◽

10.1016/j.surg.2009.06.052 ◽

2009 ◽

Vol 146 (4) ◽

pp. 543-553 ◽

Cited By ~ 120

Author(s):

Anton I. Skaro ◽

Colleen L. Jay ◽

Talia B. Baker ◽

Edward Wang ◽

Sarina Pasricha ◽

...

Keyword(s):

Liver Transplantation ◽

Cardiac Death ◽

Ischemic Cholangiopathy ◽

The Impact

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Outcome of living donor liver transplantation (LDLT): Graft survival is poor especially HCV recipients

Journal of Hepatology ◽

10.1016/s0168-8278(03)80448-8 ◽

2003 ◽

Vol 38 ◽

pp. 11-12

Author(s):

P.J. Thuluvath ◽

H.Y. Yoo

Keyword(s):

Liver Transplantation ◽

Graft Survival ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Donor Liver ◽

Donor Liver Transplantation

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Influence of donor age on graft survival after liver transplantation-united network for organ sharing registry

Liver Transplantation and Surgery ◽

10.1002/lt.500010507 ◽

1995 ◽

Vol 1 (5) ◽

pp. 311-319 ◽

Cited By ~ 56

Author(s):

Katherine M. Detre ◽

Manuel Lombardero ◽

Steven Belle ◽

Kimberly Beringer ◽

Timothy Breen ◽

...

Keyword(s):

Liver Transplantation ◽

Graft Survival ◽

Donor Age ◽

United Network

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Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

Journal of Clinical Medicine ◽

10.3390/jcm7110425 ◽

2018 ◽

Vol 7 (11) ◽

pp. 425 ◽

Cited By ~ 6

Author(s):

Kumar Jayant ◽

Isabella Reccia ◽

Francesco Virdis ◽

A. Shapiro

Keyword(s):

Liver Transplantation ◽

Blood Transfusion ◽

Graft Survival ◽

Meta Analysis ◽

Donation After Cardiac Death ◽

Clinical Trial Registry ◽

Increased Risk ◽

Increasing Demand ◽

One Year ◽

The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

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Reconstruction of Aberrant Left Hepatic Artery in Orthotopic Liver Transplantation – Single Center Experience

10.21926/obm.transplant.2101138 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Plamen Mihaylov ◽

◽

Burcin Ekser ◽

Daiki Soma ◽

Andrew Lutz ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Artery ◽

Graft Survival ◽

Arterial System ◽

Single Center ◽

Left Hepatic Artery ◽

Entire Cohort ◽

Single Center Experience ◽

Aberrant Left Hepatic Artery ◽

Low Incidence

One of the most feared complications in liver transplantation is hepatic arterial thrombosis (HAT). The incidence of HAT in liver transplantation varies from 1.2% and 8%. One of the risk factors for this complication is anatomical complexity of hepatic arterial system. The focus of this short communication is to show our approach in dealing with aberrant left hepatic artery in settings of liver transplantation. This is a single center experience. Between January 2016 and June 2019, we procured and transplanted 357 adult liver allografts. Of these, there were 34 (9.5%) livers with aberrant left hepatic artery. All of them have been reconstructed on bench table. There was no incidence of HAT in the entire cohort with ALHA. The one-year graft survival for this patient cohort was 93.1%. Our surgical approach resulted in a low incidence of HAT of 1% with excellent graft survival.

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