Is History of Coronary Artery Bypass Graft Surgery a Contraindication in Cadaveric Liver Donation? A case series

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Introductionsignificant advances in cadavaric organs ulitization has avoided growth of living donation. However, extended criteria donors (ECD) are still being neglected in many developing countries. [1] Although the organs procured from ECDs may be problematic somehow, the high rate of death in waiting list has made specialists to come up with the hard decisions of accepting the risks. [2][3]It is shown that marginal livers perform inferior defense to ischemia/reperfusion (I/R) injury, which is is responsible for graft dysfunction in ECD organs. [3] On the other hand, liver steatosis makes the organ more prone to I/R injury. [4]Outcome of fatty livers after transplantation has been shown to be under influence of severity of steatosis and donor age according to scoring systems. [5] In addition to liver cells degeneration, harmful impact of global atherosclerosis on arteries and complications of Calcified plaques should be under focus. [5] In contrast, despite broader utilization of ECD livers, discard rate from donors in our OPU after liver biopsy has been decreased due to gaining from systematic and scheduled donor management strategies. [7]Donors with history of coronary artery bypass graft surgery (CABG) are total reflection of summative cardiovascular comorbidities. In this study, fate of 14 potential deceased liver donors with a history of CABG have been investigated.MethodsAfter exclusion of cases with missing data, 14 brain dead cases with history of CABG surgery due to ischemic heart disease were identified through the last 10 years of organ donation practice. Records of both organ procurement unit and two liver transplantation centers were searched to extract donors’ data and their recipients if transplantation was performed.ResultsAmong 14 cases, 9 livers were diagnosed suitable for cadavaric donation. 1 potential donor was lost before organ retrieval. 4 livers were disapproved by the surgeons responsible for organ harvest and transplant teams due to abnormal liver appearance or biopsy findings. Mean cold ischemia time was 8.18 ± 3.2 hours. 1 out of 9 recipients died at one week after transplantation due to sepsis. Mean fallow up period was 30.5 months.ConclusionCABG surgery should not be generally a contraindication of deceased liver donation due to considerable post-transplant outcomes. therefor, carefull microscopic evaluation of the livers are mandatory before premature rejection of them.Organ Procurement Unit (OPU) Study Group. NRITLD.References1. Vodkin I, Kuo A. Extended Criteria Donors in Liver Transplantation. Clinics in Liver Disease. 2017; 21: 289–301.2. Attia M, Silva MA, Mirza DF. The marginal liver donor–an update. Transplant International. 2008;21(8):713–24.3. Saidi RF. Current status of liver transplantation. Archives of Iranian Medicine (AIM). 2012; 15: 772-776.4. Busuttil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver transplantation. 2003; 9: 651–63.5. Spitzer AL, Lao OB, Dick AA, Bakthavatsalam R, Halldorson JB, Yeh MM, Upton MP, Reyes JD, Perkins JD. The biopsied donor liver: Incorporating macrosteatosis into high‐risk donor assessment. Liver Transplantation. 2010;16: 874–84.6. Seket B, Abdelaal A, Gelas T, Pittau G, Dumortier J, Vanhems P, Boillot O. Back-table reconstruction of the donor replaced right hepatic artery prior to liver transplantation: what is the real impact on arterial complications? Hepato-gastroenterology. 2008; 56: 756–62.7. Mojtabaee M, Shamsaeefar A, Gholami S, Mohsenzadeh M, Sadegh BF. Impact of a Full-Time Donor Management Protocol on Donors' Liver Biopsy Findings: Progress to Date. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 2017; 15: 269–272.

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