title: Can we prevent ischemic-type biliary lesions in donation after circulatory determination of death liver transplantation?
abstract: The pool of livers for transplantation consists of an increasingly greater proportion of marginal grafts, in particular those arising through donation after circulatory determination of death (DCD). However, a primary factor limiting the use of marginal livers, and, thereby, the applicability of liver transplantation in general, is concern over the subsequent development of ischemic-type biliary lesion (ITBL). ITBL is a devastating complication of liver transplantation; in its most severe forms, recipients suffer frequent infectious complications that require repeated invasive biliary procedures and ultimately result in either retransplantation or death. In the present review article, we discuss our current understanding of ITBL pathogenesis as it pertains to DCD, in particular. We discuss the most relevant theories regarding its development and provide a comprehensive overview of the most promising strategies we have available today to prevent the appearance of ITBL, strategies that may, furthermore, allow us to transplant a greater proportion of marginal livers in the future. Liver Transplantation 22 1025-1033 2016 AASLD.
authors.affiliation: General and Digestive Surgery and, University of Barcelona, Barcelona, Spain.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Hessheimer
authors.affiliation: Gastrointestinal/Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Cárdenas
authors.affiliation: General and Digestive Surgery and, University of Barcelona, Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: García-Valdecasas
authors.affiliation: General and Digestive Surgery and, University of Barcelona, Barcelona, Spain.
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
mesh_terms: D064591:Allografts / Q000473:pathology*; D001659:Biliary Tract / Q000473:pathology*; D005342:Fibrinolysis; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control*; D013696:Temperature; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D009927:Tissue and Organ Procurement / Q000379:methods*