title: Biliary complications after orthotopic liver transplantation from donors after cardiac death: broad spectrum of disease.
abstract: BACKGROUND
  Donation-after-death liver transplantation (DCD-LT) carries higher complication rates compared with donation-after-brain death liver transplantation (DBD-LT). In this report we describe our experience with biliary complications in DCD-LT with emphasis on anatomical patterns and outcomes.
  
  
  METHODS
  We performed retrospective review of patients' medical records from August 2004 to December 2008, during which time total of 26 DCD-LTs were performed. Mean follow-up was 29 months (range 3 to 51 months).
  
  
  RESULTS
  Biliary complications occurred in 12 patients (46%), of whom 9 were related to DCD (35%). Four patients had more than 1 biliary complication, and 4 had concomitant arterial problems (stricture/thrombosis). Treatment of complications included: ERCP (n = 5, 3 resolved), conversion to roux (n = 5, 2 resolved), revision of roux (n = 1), percutaneous transhepatic cholangiography (n = 1), artery revision (n = 3). Three patients with casts had operative extraction of casts depicting a mummified biliary tree; histology showed casts and fibrosis and anastomotic suture material. Six patients underwent retransplantation (23%). Among retransplanted patients, 2 deaths occurred (7.7%).
  
  
  CONCLUSIONS
  Our experience with DCD-LT reveals a high prevalence of biliary complications with a new and wide spectrum of clinicopathologic findings. Better strategies for prevention of these unique biliary complications are needed to better justify the added risks and costs for performance of DCD-LT.
authors.affiliation: Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: A
authors.initials: A
authors.lastname: Abou Abbass
authors.forename: M
authors.initials: M
authors.lastname: Abouljoud
authors.forename: A
authors.initials: A
authors.lastname: Yoshida
authors.forename: D Y
authors.initials: DY
authors.lastname: Kim
authors.forename: R
authors.initials: R
authors.lastname: Slater
authors.forename: J
authors.initials: J
authors.lastname: Hundley
authors.forename: M
authors.initials: M
authors.lastname: Kazimi
authors.forename: D
authors.initials: D
authors.lastname: Moonka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D001662:Biliary Tract Surgical Procedures; D001926:Brain Death; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult