Non-anastomotic biliary strictures are more severe after trans­plan­tation of donation after circulatory death, compared to donation after brain death livers

Y. de Vries, C.I. Buis, S.V.K. Mahesh, A.P. van den Berg, R.J. Porte

Chair(s): dr. Marion J. Siebelink, programmamanager Transplantatie Centrum, UMC Groningen & dr. Raechel J. Toorop, transplantatiechirurg, UMC Utrecht

Thursday 10 march 2016

10:10 - 10:20h at Zaal 14

Categories: Parallelsessie (donatie)

Parallel session: Parallelsessie IX - Donatie en Allocatie

Livers from donation after circulatory death (DCD) donors are increasingly accepted for liver transplantation. Although, several studies have shown a higher incidence of non-anastomotic biliary strictures (NAS) after DCD liver transplantation, it is not well known whether NAS are more severe and widespread in DCD, compared to DBD liver recipients.

Aim of this study: 
To compare severity and anatomical extension of NAS in DCD and DBD liver grafts based on an established radiological grading system.

Patients and Methods:
A total of 427 adult liver transplantations performed between 2000 and 2014 were included. Radiological imaging of the biliary tree was reviewed retrospectively using an established grading system. Severity of NAS was classified as mild, moderate or severe. Anatomical localization of NAS was categorized in 4 zones of the biliary tree.

Cumulative incidence of NAS was 24% in DCD and 15% in DBD liver recipients. Moreover, NAS were more severe in DCD compared to DBD liver recipients (p=0.032). Severe biliary abnormalities were observed in 22.6 % of DBD and 47.6 % of DCD liver recipients. In addition, within the biliary tree, anatomical localization of NAS were more widespread in DCD, compared to DBD liver recipients. Of all patients who developed NAS, retransplantation for NAS was necessary in 22.6 % of DBD and 33.3 % of DCD liver recipients.

DCD liver transplantation is not only associated with a higher rate of NAS, compared to DBD transplantation, but also with a radiologically more severe and widespread presentation of NAS.