Technical Determinants of Cholangiopathy in Liver Transplantation

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MethodsDCD 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.ResultsDCD 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.ConclusionsSurgical 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.

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