Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death Results from a Matched Control Study in a Single Large Volume Center

被引:151
作者
DeOliveira, Michelle L. [1 ,2 ]
Jassem, Wayel [1 ]
Valente, Roberto [1 ]
Khorsandi, Shirin Elizabeth [1 ]
Santori, Gregorio [3 ]
Prachalias, Andreas [1 ]
Srinivasan, Parthi [1 ]
Rela, Mohamed [1 ]
Heaton, Nigel [1 ]
机构
[1] Kings Coll Hosp London, Inst Liver Dis, Div Liver Transplantat & HPB Surg, London SE5 9RS, England
[2] Univ Zurich Hosp, Dept Visceral & Transplantat Surg, Zurich, Switzerland
[3] San Martino Univ Hosp, Dept Transplantat, Genoa, Italy
关键词
HEART-BEATING DONORS; CONTROLLED NONHEARTBEATING DONORS; BILE-DUCT CELLS; ISCHEMIC CHOLANGIOPATHY; SURGICAL COMPLICATIONS; CONTROLLED DONATION; PRACTICE GUIDELINES; REPERFUSION INJURY; CENTER EXPERIENCE; ORGAN DONATION;
D O I
10.1097/SLA.0b013e318235c572
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Objective: To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution. Background: Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs. Methods: A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months. Results: Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively). Conclusions: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.
引用
收藏
页码:716 / 723
页数:8
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