Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center

Ann Surg. 2011 Nov;254(5):716-22; discussion 722-3. doi: 10.1097/SLA.0b013e318235c572.


Objective: To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution.

Background: Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs.

Methods: A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months.

Results: Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively).

Conclusions: The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biliary Tract Diseases / epidemiology*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Death
  • Female
  • Graft Survival
  • Humans
  • Infant
  • Length of Stay
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Tissue Donors
  • Young Adult