NIV Congres

Introduction Nonanastomotic strictures (NAS) are considered the Achilles heel in orthotopic liver transplantation (OLT). Donor livers from donation after cardiac death (DCD) are an important source but they are more prone to ischemia/reperfusion (IR) injury and biliary complications after OLT.

Aim Evaluation of IR-injury parameters peak aspartate aminotransferase (AST) and peak alanine aminotransferase (ALT) post-OLT as potential predictors for the development of NAS. Data such as patient, donor and operative characteristics were obtained from local anesthetic and surgical patient charts and endoscopy reports.

Methods IR-injury was defined using peak AST or peak ALT evaluated at day 4 to day 7 post-OLT. A low peak AST or ALT of < 1500 IU/L was defined as mild IR-injury whereas a high peak AST or ALT >1500 IU/L was considered as severe IR-injury. NAS was considered as any stricture or irregularity of the intra- or extrahepatic bile ducts positioned at least 1 cm above the surgical notch occurring within four years post-OLT.

Results A total of 45 OLTs were performed using DCD donors were included. Median recipient age at OLT was 57 years with a predominance of male recipients (80%). Median MELD score was 18. NAS developed in 37.8% of donor livers after OLT. DCD livers developing NAS occurred significantly more often in the group with severe IR-injury based on high peak ALT compared to the mild IR-damage evaluated by lower peak ALT (88.2% vs 11.8%, respectively, χ2=14.3, p< 0.01). Four-year cumulative incidence of NAS in the severe IR-injury group was 70% compared to 11.1% in the mild IR-injury group (p< 0.001). Multivariate analysis showed severe IR-injury, as evaluated by peak ALT >1500 IU/L, to be an independent significant risk factor for development of NAS post-OLT adjusted for CIT, WIT, peak AST, PSC as indication for OLT, recipient gender and recipient age (peak ALT >1500 IU/L aHR=11.83, 95% CI , p=0.01).

Conclusion Severe IR-injury as evaluated by high peak ALT >1500 IU/L is a very significant independent risk factor for the development of NAS post-DCD donation OLT.