Clinical outcomes of donation after circulatory death liver transplantation in primary sclerosing cholangitis

Research output: Contribution to journalArticle

Authors

  • Irene Scalera
  • Emma Slaney
  • Bridget Gunson
  • Andrea Schlegel
  • James W. Ferguson
  • Paolo Muiesan

External organisations

  • Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • University Hospital of Zurich
  • NIHR Birmingham Liver Biomedical Research Unit, Queen Elizabeth Hospital and University of Birmingham, Birmingham, United Kingdom.
  • Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham

Abstract

BACKGROUND AND AIM: Primary sclerosing cholangitis (PSC) is a progressive fibro-inflammatory cholangiopathy for which liver transplantation is the only life-extending intervention. These patients may benefit from accepting liver donation after circulatory death (DCD), however their subsequent outcome is unknown.

METHODS: Clinical outcomes were prospectively evaluated in PSC patients undergoing transplantation from 2006 to 2016 stratified by donor type (DCD, n=35 vs. donation after brain death [DBD], n=108).

RESULTS: In liver transplantation for PSC; operating time, days requiring critical care support, total ventilator days, incidence of acute kidney injury, need for renal replacement therapy (RRT) or total days requiring RRT were not significantly different between DCD vs. DBD recipients. Although the incidence of ischaemic-type biliary lesions was greater in the DCD group (incidence rate [IR]: 4.4 vs. 0 cases/100-pt.-yrs; p<0.001) there was no increased risk of post-transplant biliary strictures overall (hazard ratio [HR]: 1.20, 0.58-2.46;p=0.624), or in sub-analysis specific to anastomotic strictures or recurrent PSC, between donor types. Graft loss and mortality rates were not significantly different following transplantation with DCD vs. DBD livers (IR: 3.6 vs. 3.1 cases/100-pt.-yrs, p=0.34; and 3.9 vs. 4.7, p=0.6; respectively). DCD liver transplantation in PSC did not impart a heightened risk of graft loss (HR: 1.69, 0.58-4.95, p=0.341) or patient mortality (0.75, 0.25-2.21, p=0.598).

CONCLUSION: Transplantation with DCD (vs. DBD) livers in PSC does not impact graft loss or patient survival. In an era of organ shortage, DCD grafts represent a viable therapeutic option for liver transplantation in PSC patients.

LAY SUMMARY: This study examines the impact of liver transplantation in primary sclerosing cholangitis (PSC) with organs donated after circulatory death (DCD), compared to donation after brainstem death (DBD). We show that in appropriately selected patients, the outcomes for DCD transplantation mirror those using DBD livers, with no significant differences in complication rate, patient survival or transplanted liver survival. In an era of organ shortage and increasing wait-list times, DCD livers represent a potential treatment option for transplantation in PSC.

Bibliographic note

Initially submitted under title: Donation after circulatory death liver transplantation does not impact patient or graft survival in primary sclerosing cholangitis

Details

Original languageEnglish
Pages (from-to)957-965
JournalJournal of Hepatology
Volume67
Issue number5
Early online date8 Jul 2017
Publication statusPublished - Nov 2017

Keywords

  • Primary sclerosing cholangitis, liver transplantation, ulcerative colitis, ischaemic-type biliary lesion, non-anastomotic biliary stricture, hepatic artery thrombosis, non-heartbeating donor, risk stratification