Incidence of Biliary and Arterial Complications Using Liver Grafts from 70 to 94 Years Old
Carlos Muñoz-Arce1, Oscar Caso1, Iago Justo1, Alberto A. Marcacuzco1, Félix Cambra1, Alejandro Manrique1, Jorge Calvo1, Santiago Salamea1, Alvaro García-Sesma1, Carlos Jiménez1.
1Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, Spain
Introduction:The use of old liver grafts for liver transplantation (LT) has shown good results in recent years. It has been reported a higher rate of biliary and arterial complications when old liver grafts are used for LT in comparison with the use of younger donors. Our aim is to analyze the biliary and arterial complications after LT comparing recipients of donors ≥70 years versus recipients of donors < 65 years.
Materials and Methods:A retrospective and longitudinal study was performed, comparing the incidence of biliary and arterial complications after LT between group A (recipients of donors > 70 years) and group B (recipients of donors <65 years).
Results: From April 1994 to May 2016, 212 LT were performed using donors ≥70 years and 212 LT< 65 years. Piggy-back technique and choledocho-choledochostomy without T-tube was performed in all cases. Tacrolimus was the basal immunosuppression.
A total of 16 (7.5%) patients developed biliary complications in group A: 11 (5.2%) stenosis, 3 (1.4%) fistulas, and 2 (0.94%) ischemic cholangiopathies; versus 22 (10.4%) biliary complications in group B: 13 (6.1%) stenosis, 6 (2.8%) fistulas, and 3 (1.4%) cholangiopathies (p=0.19). There was a total of 14 (6.6%) patients who developed vascular complications in group A: 9 (4.2%) thrombosis, and 5 (2.3%) stenosis; versus 11 (5.2%) vascular complications in group B: 8 (3.8%) arterial thrombosis, 1 (0.5%) arterial stenosis and 2 (0.9%) portal thrombosis (p=0.56).
Five patients (2.35%) presented simultaneous biliary and arterial complications: 3 (1.4%) biliary stenosis with arterial thrombosis, and 2 (0.9%) ischemic cholangiopathies with arterial thrombosis. It should be noted that the development of arterial and biliary complications was associated with a higher rate of complications, medical, infectious, vascular, cardiovascular, respiratory, post-transplant renal failure, having a longer time of stay in the ICU.
Conclusions: The rates of vascular and biliary complications in LT were similar in recipients of liver grafts > 70 years and recipients of donors < 65 years.
