The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: The untold story

Background. Liver transplanatation (LT from donation after cardiac death (DCD) donors is increasingly being used to address organ shortages. Depute encouraging reports, standard survival metrics have overestrinated the effectiveness of DCD livers. We exammed the mode, kinetics and predictors of organ failure and resource utilization of more fully characterize outcomes after DCD LT Methods. We reviewed the outcomes for 32 DCD and 237 donation after brain death (DBD) LT recipients at our institution. Results. Recipients of DCD livers had a 2.1 times greater risk of graft failure, a 2.5 times greater risk of relisting, and a 3.2 times greater risk of retransplantation compared with DBD recipients. DCD recipients had a 31.6% higher incidence of biliary complications and a 35.8% higher incidence of ischemic cholangropathy Ischemic cholangrography was primarily implicated in the higher risk of graft failure observed after DCD LT. DCD recipients with ischemic cholangiography experienced more frequent rehospitalizations, longer hospital stays, and required more invasive biliary procedures. Conclusion. Related to higher complication rates, DCD recipients necessitated greater resource utilization This more granular data should be considered in the decision to promote DCD LT. Modification of liver allocation policy is necessary to address those disadvantaged by failuing DCD graft. (Surgery 2009:146-543-53)