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IS ULTRA-SHORT COLD ISCHEMIA THE KEY TO ISCHEMIC CHOLANGIOPATHY AVOIDANCE IN DCD-LT?
O Detry, A Deroover, S Cheham, H Ledinh, C Coimbra, E Decker, L Kohnen, MF Hans, J Joris, S Lauwick, A
Kaba, J Delwaide, M Meurisse, P Honoré
University of Liege, CHU Liege, Belgium
Donation after circulatory death (DCD) liver transplantation (LT) has been
introduced to partially overcome the organ donor shortage
DCD LT has lower graft survival due to increase rates of primary non-function and
graft loss due to ischemic cholangiopathy with difficult to treat non-anastomotic
biliary strictures
Aim: Report the authors‘ experience in DCD-LT, with a short cold ischemia time and
without upper limit age criteria
-
Retrospective 10 years monocentric experience
Center-oriented allocation within the Eurotransplant organisation
No upper limit DCD donor age criteria
70 consecutive DCD-LT
DCD in OR, with heparin and donor comfort therapy
Death on circulatory criteria
5 min no-touch period
Median
n
IQR
DONORS
Age (years)
DRI
59
2.1
44.7 – 70
1.8-2.5
RECIPIENTS
Age (years)
Lab MELD
58.5
15
51.7-64
11-20
RECIPIENTS
indication
HCC on cirrhotic liver
Other cancers
Cirrhosis without cancer
ReTx for HAT
26
6
36
2
PROCEDURES
DWIT (min)
Withdrawal phase (min)
Acirculatory phase
19.5
11
9
16 – 24
7-15.5
8-10
CIT (min)
Total ischemia
235.5
292
200-285
268-340
Median/n/%
Peak AST (UI/L)
1,163
702-2,810
Peak total bili (mg/dL)
30.4
18.6-62.2
PNF (n)
0
HAT (n)
1
1 year graft survival
91.3%
3 year graft survival
77.7%
Graft loss
HAT: 1, cancer: 8, MOF: 4,
Intrahepatic symptomatic NA stricture
0
other: 2
- DCD may be a valuable source of liver grafts
- DWIT < 30 min & CIT < 5 hours may lead to a low rate of graft loss due to PNF and/or ischemic
cholangiopathy
- With DWIT < 30 min & CIT < 5 hours, DCD donors > 60 years sould be considered to really
increase the cadaveric donor pool