Poster 14. Donor hematocrit is an independent predictor for the development of non-anastomotic biliary strictures after donation after circulatory death liver transplantation

Thursday 14 march 2019

13:09 - 13:12h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 3 - Clinical

O.B. van Leeuwen1, M. van Reeven2, J.N.M. IJzermans2, V.E. de Meijer1, W.G. Polak2, R.J. Porte1

1Dept. of Surgery, University Medical Center Groningen, Groningen.2Dept. of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

Background: Donation after circulatory death (DCD) livers are increasingly used for transplantation to overcome donor organ shortage. These livers, however, develop non-anastomotic biliary strictures (NAS) in up to 30%, frequently resulting in graft loss or even death. The high incidence of NAS cannot be completely explained by the currently known risk factors. Blood hematocrit is a determinant of blood viscosity and might therefore affect graft flush out during procurement. We aimed to investigate the impact of donor hematocrit (among other known risk factors) on the development of NAS after DCD liver transplantation. 

Methods: DCD liver transplantations performed between 2003-2017 in the two participating centers were included. Exclusion criteria were retransplantation, use of machine perfusion and unknown donor hematocrit. NAS was defined as bile duct strictures at any location but the anastomosis. Continuous data are expressed as median (interquartile range). Uni- and multivariate logistic regression analysis were used to identify risk factors for the development of NAS. Variables with a p-value below 0.2 in the univariate analysis were included in the multivariate analysis.

Results: A total of 235 DCD liver transplantations were included. Median donor hematocrit was 34 (30-39) %, donor age 47 (36-54) years, time between withdrawal of life support and cold perfusion 31 (26-38) min, and cold ischemia time (CIT) 408 (356-460) min. Univariate analysis identified donor age (p=0.005), CIT (p=0.102), time between withdrawal of life support and cold flush (p=0.107) and donor hematocrit (p=0.045) as (near) significant risk factors for NAS. After multivariate analysis, only donor hematocrit (OR 1.054, 95% CI: 1.003-1.108, p=0.039) remained as an independent risk factor for NAS. Livers from DCD donors with a hematocrit >36% had a more than 2-fold higher risk to develop NAS. 

Conclusions: Donor hematocrit is a strong risk factor for the development of NAS after DCD liver transplantation.