BACKGROUND: Hepatic allografts from non-heart-beating donors (NHBD) have been cited as a means to expand the supply of donor livers. Concern exists that donor warm ischemic time in addition to subsequent cold ischemia-reperfusion injury may result in damage to sensitive cell populations within the liver. Because the biliary epithelium is sensitive to ischemia-reperfusion injury, the authors surmised that an increased incidence of biliary complications might occur among recipients of an NHBD allograft. METHODS: This study was a retrospective evaluation of NHBD recipients compared to a group of heart-beating donor (HBD) recipients from a single institution. RESULTS: Fifteen patients received a hepatic allograft from a controlled NHBD donor. NHBD and HBD (n=221) graft survival did not differ at 1 (71.8% vs. 85.4%, P=0.23) or 3 years (71.8% vs. 73.9%, P=0.68). Patient survival at 1 (79% vs. 90.9%, P=0.16) and 3 years (79.0% vs. 77.7%, P=0.8) was also similar. Major biliary complications occurred in five (33.3%) NHBD recipients; 66.6% of the NHBD biliary complications consisted of intrahepatic strictures versus 19.2% among HBD recipients (P<0.01). Major biliary complications in the NHBD recipients resulted in multiple interventional procedures, retransplantation, and death. CONCLUSIONS: Donor warm ischemic time may predispose hepatic allografts to an increased incidence of ischemic type strictures. Although graft and patient survival was similar to a cohort of HBD recipients, caution is urged with the use of these organs.
BACKGROUND: Hepatic allografts from non-heart-beating donors (NHBD) have been cited as a means to expand the supply of donor livers. Concern exists that donor warm ischemic time in addition to subsequent cold ischemia-reperfusion injury may result in damage to sensitive cell populations within the liver. Because the biliary epithelium is sensitive to ischemia-reperfusion injury, the authors surmised that an increased incidence of biliary complications might occur among recipients of an NHBD allograft. METHODS: This study was a retrospective evaluation of NHBD recipients compared to a group of heart-beating donor (HBD) recipients from a single institution. RESULTS: Fifteen patients received a hepatic allograft from a controlled NHBD donor. NHBD and HBD (n=221) graft survival did not differ at 1 (71.8% vs. 85.4%, P=0.23) or 3 years (71.8% vs. 73.9%, P=0.68). Patient survival at 1 (79% vs. 90.9%, P=0.16) and 3 years (79.0% vs. 77.7%, P=0.8) was also similar. Major biliary complications occurred in five (33.3%) NHBD recipients; 66.6% of the NHBD biliary complications consisted of intrahepatic strictures versus 19.2% among HBD recipients (P<0.01). Major biliary complications in the NHBD recipients resulted in multiple interventional procedures, retransplantation, and death. CONCLUSIONS:Donor warm ischemic time may predispose hepatic allografts to an increased incidence of ischemic type strictures. Although graft and patient survival was similar to a cohort of HBD recipients, caution is urged with the use of these organs.
Authors: Colleen L Jay; Anton I Skaro; Daniela P Ladner; Edward Wang; Vadim Lyuksemburg; Yaojen Chang; Hongmei Xu; Sandhya Talakokkla; Neehar Parikh; Jane L Holl; Gordon B Hazen; Michael M Abecassis Journal: Liver Transpl Date: 2012-06 Impact factor: 5.799
Authors: Umberto Baccarani; Anna Rossetto; Dario Lorenzin; Stefania Bidinost; Maria Laura Pertoldeo; Manuela Lugano; Vittorio Bresadola; Giorgio Della Rocca; Andrea Risaliti; Gian Luigi Adani Journal: Updates Surg Date: 2012-07-07
Authors: Roberto Hernandez-Alejandro; Yves Caumartin; Cameron Chent; Mark A Levstik; Douglas Quan; Norman Muirhead; Andrew A House; Vivian McAlister; Anthony M Jevnikar; Patrick P W Luke; William Wall Journal: Can J Surg Date: 2010-04 Impact factor: 2.089
Authors: Alberto Lué; Estela Solanas; Pedro Baptista; Sara Lorente; Juan J Araiz; Agustin Garcia-Gil; M Trinidad Serrano Journal: World J Gastroenterol Date: 2016-06-07 Impact factor: 5.742
Authors: Emre A Eren; Nicholas Latchana; Eliza Beal; Don Hayes; Bryan Whitson; Sylvester M Black Journal: Exp Clin Transplant Date: 2016-10 Impact factor: 0.945