Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications.
BACKGROUND
Hepatic allografts from non-heart-beating donors (NHBD) have been cited as a means to expand the supply of donor livers. Concern exists that donor warm ischemic time in addition to subsequent cold ischemia-reperfusion injury may result in damage to sensitive cell populations within the liver. Because the biliary epithelium is sensitive to ischemia-reperfusion injury, the authors surmised that an increased incidence of biliary complications might occur among recipients of an NHBD allograft.


METHODS
This study was a retrospective evaluation of NHBD recipients compared to a group of heart-beating donor (HBD) recipients from a single institution.


RESULTS
Fifteen patients received a hepatic allograft from a controlled NHBD donor. NHBD and HBD (n=221) graft survival did not differ at 1 (71.8% vs. 85.4%, P=0.23) or 3 years (71.8% vs. 73.9%, P=0.68). Patient survival at 1 (79% vs. 90.9%, P=0.16) and 3 years (79.0% vs. 77.7%, P=0.8) was also similar. Major biliary complications occurred in five (33.3%) NHBD recipients; 66.6% of the NHBD biliary complications consisted of intrahepatic strictures versus 19.2% among HBD recipients (P<0.01). Major biliary complications in the NHBD recipients resulted in multiple interventional procedures, retransplantation, and death.


CONCLUSIONS
Donor warm ischemic time may predispose hepatic allografts to an increased incidence of ischemic type strictures. Although graft and patient survival was similar to a cohort of HBD recipients, caution is urged with the use of these organs.
Abt
Peter
P
Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Crawford
Michael
M
Desai
Niraj
N
Markmann
James
J
Olthoff
Kim
K
Shaked
Abraham
A
D000328:Adult; D001653:Bile Ducts, Intrahepatic; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D003251:Constriction, Pathologic; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009200:Myocardial Contraction; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome