Technical Determinants of Cholangiopathy in Liver Transplantation. (July 2018)

• Record Type: Journal Article
• Authors: Alvarez-Casas, Josue; LaMattina, John C; Sultan, Samuel T; Hanish, Steven I; Bruno, David A; Hutson, William R; Malik, Saad; Bartlett, Stephen T; Barth, Rolf N
• Is Part Of: Transplantation. Volume 102(2018)Supplement 7S-1
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000542778.78597.54
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Methods: DCD liver transplants from 2005-2017 were reviewed.Warm ischemic times were generally maintained below 30 minutes. Rapid surgical extraction technique was performed wth two surgeons explanting the liver and submerging in 4 o C preservation solution.IC was diagnosed based on elevated bilirubin, biopsy and endoscopic images. Results: DCD liver transplants were performed in 108 patients with mean MELD 23∓8. Mean donor age was 32∓10 (range 9-56) years. Mean donor warm ischemic time was 21∓7 (range 6-43). Time from incision to cross clamp was less than 3 minutes. Time from incision to donor liver explant was 18∓11min. Total cold ischemic time was 4.9∓1.8 hours. One-year patient and graft survival was 86% and 82% respectively. Biliary Lesions consistent with IC occured in 8 patients requiring a total 28 percutaneous or endoscopic interventions. IC resolved in 6 patients; the other 2 required re-transplantation. Conclusions: Surgical approach of rapid extraction can mitigate high rates of IC without additional pharmacoloical or mechanical strategies. Changes consistent with IC can resolve with endoscopic therapies.