Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation.
Ischemic-type biliary lesions (ITBL) account for a major part of patients' morbidity and mortality after orthotopic liver transplantation (OLT). The exact origin of this type of biliary complication remains unknown. This study retrospectively evaluated 1843 patients. Patients with primary sclerosing cholangitis were excluded from this study. The diagnosis of ITBL was established only when all other causes of destruction of the biliary tree were ruled out. Donor age (P = 0.028) and cold ischemic time (CIT) (P = 0.002) were found to be significant risk factors for the development of ITBL. Organs that were perfused with University of Wisconsin (UW) solution developed ITBL significantly more often than Histidine-Tryptophan-Ketoglutarate (HTK)-perfused organs (P = 0.036). The same applied to organs harvested externally and shipped to our center versus those that were procured locally by our harvest teams (P < 0.001). Pressure perfusion via the hepatic artery significantly reduced the risk of ITBL (P = 0.001). The only recipient factor that showed a significant influence was Child-Pugh score status C (P = 0.021). Immunologic factors had no significant impact on ITBL. The clinical consequences of this study for our institution have been the strict limitation of CIT to <10 h and the exclusive use of HTK solution. We further advocate that all organ procurement teams perform pressure perfusion on harvested organs.
Heidenhain
Christoph
C
Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, University Medicine Berlin Augustenburger Platz 1, Berlin, Germany. christoph.heidenhain@charite.de
Pratschke
Johann
J
Puhl
Gero
G
Neumann
Ulf
U
Pascher
Andreas
A
Veltzke-Schlieker
Winfried
W
Neuhaus
Peter
P
D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000493:Allopurinol / Q000009:adverse effects; D001604:Berlin / Q000453:epidemiology; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology; D050377:Cold Ischemia / Q000009:adverse effects*; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D005978:Glutathione / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000009:adverse effects; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000009:adverse effects; D010477:Perfusion / Q000009:adverse effects / Q000379:methods; D011189:Potassium Chloride / Q000627:therapeutic use; D011312:Pressure; D011343:Procaine / Q000627:therapeutic use; D011887:Raffinose / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000592:standards
C039984:Bretschneider cardioplegic solution; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose