Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors

C. Burcin Taner, Ilynn G. Bulatao, Dana K. Perry, Lena Sibulesky, Darrin L. Willingham, David J. Kramer, Justin H. Nguyen

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

This study sought to determine the procurement factors that lead to development of intrahepatic bile duct strictures (ITBS) and overall biliary complications in recipients of donation after cardiac death (DCD) liver grafts. Detailed information for different time points during procurement (withdrawal of support; SBP < 50 mmHg; oxygen saturation <30%; mandatory wait period; asystole; incision; aortic cross clamp) and their association with the development of ITBS and overall biliary complications were examined using logistic regression. Two hundred and fifteen liver transplants using DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Of all the time periods during procurement, only asystole-cross clamp period was significantly different between patients with ITBS versus no ITBS (P = 0.048) and between the patients who had overall biliary complications versus no biliary complications (P = 0.047). On multivariate analysis, only asystole-cross clamp period was significant predictor for development of ITBS (P = 0.015) and development of overall biliary complications (P = 0.029). Hemodynamic changes in the agonal period did not emerge as risk factors. The results of the study raise the possibility of utilizing asystole-cross-clamp period in place of or in conjunction with donor warm ischemia time in determining viability or quality of liver grafts.

Original languageEnglish (US)
Pages (from-to)838-846
Number of pages9
JournalTransplant International
Volume25
Issue number8
DOIs
StatePublished - Aug 1 2012

Keywords

  • bile ducts
  • donation after cardiac death
  • graft survival
  • liver transplantation
  • postoperative complications
  • tissue and organ procurement

ASJC Scopus subject areas

  • Transplantation

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