Technical Determinants of Cholangiopathy in Liver Transplantation

    loading  Checking for direct PDF access through Ovid

Abstract

Methods

DCD liver transplants from 2005-2017 were reviewed.Warm ischemic times were generally maintained below 30 minutes. Rapid surgical extraction technique was performed wth two surgeons explanting the liver and submerging in 4o C preservation solution.IC was diagnosed based on elevated bilirubin, biopsy and endoscopic images.

Results

DCD liver transplants were performed in 108 patients with mean MELD 23∓8. Mean donor age was 32∓10 (range 9-56) years. Mean donor warm ischemic time was 21∓7 (range 6-43). Time from incision to cross clamp was less than 3 minutes. Time from incision to donor liver explant was 18∓11min. Total cold ischemic time was 4.9∓1.8 hours. One-year patient and graft survival was 86% and 82% respectively. Biliary Lesions consistent with IC occured in 8 patients requiring a total 28 percutaneous or endoscopic interventions. IC resolved in 6 patients; the other 2 required re-transplantation.

Conclusions

Surgical approach of rapid extraction can mitigate high rates of IC without additional pharmacoloical or mechanical strategies. Changes consistent with IC can resolve with endoscopic therapies.

Related Topics

    loading  Loading Related Articles