Biliary Strictures After Liver Transplantation with Grafts from Donors After Cardiac Death: Narrowing Down the Etiologies

Excerpt

Liver transplantation (LT) is the standard-of-care for patients with end-stage liver disease. With improving techniques, graft and patient outcomes are excellent. The number of orthotopic LTs in the USA is on the rise; since demand for livers continues to exceed supply, transplant centers are constantly expanding donor liver utilization criteria [1]. Traditionally, allografts that are obtained through donation after brain death (DBD) have been the principal source of liver allograft donor pool. Donation after cardiac death (DCD) is on the rise in the USA and is becoming a rapidly growing source of liver allografts to fill the gap in organ scarcity. Unlike DBD grafts, livers from DCD suffer from a variable form of ischemia. Hence, DCD allografts are at a higher risk of developing biliary complications (biliary strictures and ischemic cholangiopathy), with resultant graft loss and death [2]. An analysis of the national registry of LT recipients database showed that DCD allografts experienced inferior survival at 1 and 3 years as well as a higher risk of re-transplantation compared to DBD recipients [3]. Similar results were reported in a prospective multicenter study in the UK [4]. Despite recent advances in treatments for biliary strictures after LT, they continue to be of concern as they are observed in approximately in 5–15% of patients following deceased donor LT and 28–32% following living donor LTs [5]. …