Surgery
Volume 146, Issue 4 , Pages 543-553, October 2009

The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: The untold story

  • Anton I. Skaro, MD, PhD

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • Corresponding Author InformationReprint requests: Anton I. Skaro, MD, PhD, Division of Organ Transplantation, Northwestern University, Feinberg School of Medicine, Galter Pavilion 17-200, Chicago, IL 60611.
    • ,
  • Colleen L. Jay, MD

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Talia B. Baker, MD

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Edward Wang, PhD

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Sarina Pasricha, BS

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Vadim Lyuksemburg, BS

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • John A. Martin, MD

      Affiliations

    • Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Joseph M. Feinglass, PhD

      Affiliations

    • Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Luke B. Preczewski

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • ,
  • Michael M. Abecassis, MD, MBA

      Affiliations

    • Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL

Accepted 9 June 2009.

Background

Liver transplantation (LT) from donation after cardiac death (DCD) donors is increasingly being used to address organ shortages. Despite encouraging reports, standard survival metrics have overestimated the effectiveness of DCD livers. We examined the mode, kinetics, and predictors of organ failure and resource utilization to more fully characterize outcomes after DCD LT.

Methods

We reviewed the outcomes for 32 DCD and 237 donation after brain death (DBD) LT recipients at our institution.

Results

Recipients of DCD livers had a 2.1 times greater risk of graft failure, a 2.5 times greater risk of relisting, and a 3.2 times greater risk of retransplantation compared with DBD recipients. DCD recipients had a 31.6% higher incidence of biliary complications and a 35.8% higher incidence of ischemic cholangiopathy. Ischemic cholangiography was primarily implicated in the higher risk of graft failure observed after DCD LT. DCD recipients with ischemic cholangiography experienced more frequent rehospitalizations, longer hospital stays, and required more invasive biliary procedures.

Conclusion

Related to higher complication rates, DCD recipients necessitated greater resource utilization. This more granular data should be considered in the decision to promote DCD LT. Modification of liver allocation policy is necessary to address those disadvantaged by a failing DCD graft.

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 Research for this paper was done while the author (C.J.) was a National Research Service Award postdoctoral fellow with the Division of Organ Transplantation at Northwestern University, Feinberg School of Medicine under an institutional award from the National Institute of Diabetes and Digestive and Kidney Diseases, 5 T32 DK077662-02 (PI: Michael Abecassis, MD MBA).

 A.I.S. and C.L.J. contributed equally to this manuscript.

PII: S0039-6060(09)00476-0

doi:10.1016/j.surg.2009.06.052

Surgery
Volume 146, Issue 4 , Pages 543-553, October 2009

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