Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors

C. Burcin Taner, Ilynn G. Bulatao, Darrin L. Willingham, Dana K. Perry, Lena Sibulesky, Surakit Pungpapong, Jaime Aranda-Michel, Andrew P. Keaveny, David J. Kramer, Justin H Nguyen

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Abstract

The use of donation after cardiac death (DCD) liver grafts is controversial because of the overall increased rates of graft loss and morbidity, which are mostly related to the consequences of ischemic cholangiopathy (IC). In this study, we sought to determine the factors leading to graft loss and the development of IC and to compare patient and graft survival rates for recipients of DCD liver grafts and recipients of donation after brain death (DBD) liver grafts in a large series at a single transplant center. Two hundred liver transplants with DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Logistic regression models were used in the univariate and multivariate analyses of predictors for the development of IC. Additional analyses using Cox regression models were performed to identify predictors of graft survival and to compare outcomes for DCD and DBD graft recipients. In our series, the patient survival rates for the DCD and DBD groups at 1, 3, and 5 years was 92.6%, 85%, and 80.9% and 89.8%, 83.0%, and 76.6%, respectively (P = not significant). The graft survival rates for the DCD and DBD groups at 1, 3, and 5 years were 80.9%, 72.7%, and 68.9% and 83.3%, 75.1%, and 68.6%, respectively (P = not significant). In the DCD group, 5 patients (2.5%) had primary nonfunction, 7 patients (3.5%) had hepatic artery thrombosis, and 3 patients (1.5%) experienced hepatic necrosis. IC was diagnosed in 24 patients (12%), and 11 of these patients (5.5%) required retransplantation. In the multivariate analysis, the asystole-to-cross clamp duration [odds ratio = 1.161, 95% confidence interval (CI) = 1.021-1.321] and African American recipient race (odds ratio = 5.374, 95% CI = 1.368-21.103) were identified as significant factors for predicting the development of IC (P <0.05). This study has established a link between the development of IC and the asystole-to-cross clamp duration. Procurement techniques that prolong the nonperfusion period increase the risk for the development of IC in DCD liver grafts.

Original languageEnglish (US)
Pages (from-to)101-112
Number of pages12
JournalLiver Transplantation
Volume18
Issue number1
DOIs
StatePublished - Jan 2012

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Liver Transplantation
Tissue Donors
Transplants
Brain Death
Liver
Graft Survival
Survival Rate
Heart Arrest
Multivariate Analysis
Logistic Models
Odds Ratio
Confidence Intervals
Hepatic Artery
Proportional Hazards Models
African Americans
Thrombosis
Necrosis
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors. / Taner, C. Burcin; Bulatao, Ilynn G.; Willingham, Darrin L.; Perry, Dana K.; Sibulesky, Lena; Pungpapong, Surakit; Aranda-Michel, Jaime; Keaveny, Andrew P.; Kramer, David J.; Nguyen, Justin H.

In: Liver Transplantation, Vol. 18, No. 1, 01.2012, p. 101-112.

Research output: Contribution to journalArticle

Taner, CB, Bulatao, IG, Willingham, DL, Perry, DK, Sibulesky, L, Pungpapong, S, Aranda-Michel, J, Keaveny, AP, Kramer, DJ & Nguyen, JH 2012, 'Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors', Liver Transplantation, vol. 18, no. 1, pp. 101-112. https://doi.org/10.1002/lt.22404
Taner, C. Burcin ; Bulatao, Ilynn G. ; Willingham, Darrin L. ; Perry, Dana K. ; Sibulesky, Lena ; Pungpapong, Surakit ; Aranda-Michel, Jaime ; Keaveny, Andrew P. ; Kramer, David J. ; Nguyen, Justin H. / Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors. In: Liver Transplantation. 2012 ; Vol. 18, No. 1. pp. 101-112.
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abstract = "The use of donation after cardiac death (DCD) liver grafts is controversial because of the overall increased rates of graft loss and morbidity, which are mostly related to the consequences of ischemic cholangiopathy (IC). In this study, we sought to determine the factors leading to graft loss and the development of IC and to compare patient and graft survival rates for recipients of DCD liver grafts and recipients of donation after brain death (DBD) liver grafts in a large series at a single transplant center. Two hundred liver transplants with DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Logistic regression models were used in the univariate and multivariate analyses of predictors for the development of IC. Additional analyses using Cox regression models were performed to identify predictors of graft survival and to compare outcomes for DCD and DBD graft recipients. In our series, the patient survival rates for the DCD and DBD groups at 1, 3, and 5 years was 92.6{\%}, 85{\%}, and 80.9{\%} and 89.8{\%}, 83.0{\%}, and 76.6{\%}, respectively (P = not significant). The graft survival rates for the DCD and DBD groups at 1, 3, and 5 years were 80.9{\%}, 72.7{\%}, and 68.9{\%} and 83.3{\%}, 75.1{\%}, and 68.6{\%}, respectively (P = not significant). In the DCD group, 5 patients (2.5{\%}) had primary nonfunction, 7 patients (3.5{\%}) had hepatic artery thrombosis, and 3 patients (1.5{\%}) experienced hepatic necrosis. IC was diagnosed in 24 patients (12{\%}), and 11 of these patients (5.5{\%}) required retransplantation. In the multivariate analysis, the asystole-to-cross clamp duration [odds ratio = 1.161, 95{\%} confidence interval (CI) = 1.021-1.321] and African American recipient race (odds ratio = 5.374, 95{\%} CI = 1.368-21.103) were identified as significant factors for predicting the development of IC (P <0.05). This study has established a link between the development of IC and the asystole-to-cross clamp duration. Procurement techniques that prolong the nonperfusion period increase the risk for the development of IC in DCD liver grafts.",
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AU - Perry, Dana K.

AU - Sibulesky, Lena

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N2 - The use of donation after cardiac death (DCD) liver grafts is controversial because of the overall increased rates of graft loss and morbidity, which are mostly related to the consequences of ischemic cholangiopathy (IC). In this study, we sought to determine the factors leading to graft loss and the development of IC and to compare patient and graft survival rates for recipients of DCD liver grafts and recipients of donation after brain death (DBD) liver grafts in a large series at a single transplant center. Two hundred liver transplants with DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Logistic regression models were used in the univariate and multivariate analyses of predictors for the development of IC. Additional analyses using Cox regression models were performed to identify predictors of graft survival and to compare outcomes for DCD and DBD graft recipients. In our series, the patient survival rates for the DCD and DBD groups at 1, 3, and 5 years was 92.6%, 85%, and 80.9% and 89.8%, 83.0%, and 76.6%, respectively (P = not significant). The graft survival rates for the DCD and DBD groups at 1, 3, and 5 years were 80.9%, 72.7%, and 68.9% and 83.3%, 75.1%, and 68.6%, respectively (P = not significant). In the DCD group, 5 patients (2.5%) had primary nonfunction, 7 patients (3.5%) had hepatic artery thrombosis, and 3 patients (1.5%) experienced hepatic necrosis. IC was diagnosed in 24 patients (12%), and 11 of these patients (5.5%) required retransplantation. In the multivariate analysis, the asystole-to-cross clamp duration [odds ratio = 1.161, 95% confidence interval (CI) = 1.021-1.321] and African American recipient race (odds ratio = 5.374, 95% CI = 1.368-21.103) were identified as significant factors for predicting the development of IC (P <0.05). This study has established a link between the development of IC and the asystole-to-cross clamp duration. Procurement techniques that prolong the nonperfusion period increase the risk for the development of IC in DCD liver grafts.

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