The most significant barrier to increase use of donation after cardiac death (DCD) donor livers for transplantation is concerns for high rates of ischemic cholangiopathy (IC, mean 16%) and subsequent graft loss. Recent reports have suggested thrombolytic therapies, induction immunosuppression, and ex vivo perfusion strategies to minimize this effect. We report experience utilizing rapid surgical extraction techniques without any additional therapies.
Methods: DCD liver transplants from 2005-2017 were reviewed . Warm ischemic times were generally maintained below 30 minutes. Rapid surgical extraction technique was performed wth two surgeons explanting the liver and submerging in 4^o C preservation solution . IC was diagnosed based on elevated bilirubin, biopsy and endoscopic images.
Results: DCD liver transplants were performed in 108 patients with mean MELD 23∓8. Mean donor age was 32∓10 (range 9-56) years. Mean donor warm ischemic time was 21∓7 (range 6-43). Time from incision to cross clamp was less than 3 minutes. Time from incision to donor liver explant was 18∓11min. Total cold ischemic time was 4.9∓1.8 hours. One-year patient and graft survival was 86% and 82% respectively. Biliary Lesions consistent with IC occured in 8 patients requiring a total 28 percutaneous or endoscopic interventions. IC resolved in 6 patients; the other 2 required re-transplantation.
Conclusions: Surgical approach of rapid extraction can mitigate high rates of IC without additional pharmacoloical or mechanical strategies. Changes consistent with IC can resolve with endoscopic therapies.