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Predictors of Biliary Strictures After Liver Transplantation Among Recipients of DCD (Donation After Cardiac Death) Grafts

  • Divyanshoo R. KohliEmail author
  • M. Edwyn Harrison
  • Abimbola O. Adike
  • Bara El Kurdi
  • Norio Fukami
  • Douglas O. Faigel
  • Rahul Pannala
  • Adyr A. Moss
  • Bashar A. Aqel
Original Article
  • 32 Downloads

Abstract

Introduction

Biliary strictures are a common complication among donation after cardiac death (DCD) liver transplantation (LT) recipients and may require multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. We evaluated the risk factors associated with development of biliary strictures in DCD LT recipients.

Methods

DCD LT recipients who underwent transplantation from 2012 to 2017 were divided into 2 groups: (a) those with anastomotic or non-anastomotic biliary strictures who required ERCP (“stricture group”) and (b) those who did not require ERCP or had cholangiograms without evidence of biliary strictures (“non-stricture group”). Clinical data, cholangiograms and laboratory values at day 0 and day 7 after LT were compared between the two groups.

Results

Forty-nine of the 100 DCD LT recipients underwent ERCP. Thirty-four of these 49 LT recipients had evidence of anastomotic or non-anastomotic biliary strictures (stricture group), while the remaining 66 LT recipients comprised the non-stricture group. Donor age was significantly higher in stricture group compared to non-stricture group (49.2 ± 1.8 vs 42.8 ± 1.57 years, respectively; p = 0.01). The stricture group had a significantly higher total bilirubin at day 0 (3.5 ± 0.37 vs 2.6 ± 0.21 mg/dL; p = 0.02) and INR at day 7 (1.24 ± 0.06 vs 1.13 ± 0.01; p = 0.048) compared to the non-stricture group. Multi-variate analysis demonstrated significant association between biliary strictures and total bilirubin at day 0 of LT and age of donor.

Conclusion

Biliary strictures occur frequently in DCD LT recipients and may be associated with older age of donor. Hyperbilirubinemia immediately after transplant and higher INR in the first 7 days after transplant may predict subsequent development of biliary strictures.

Keywords

Biliary strictures Donation after cardiac death Liver transplant 

Abbreviations

ERCP

Endoscopic retrograde cholangiopancreatography

LT

Liver transplant

DCD

Donation after cardiac death

DBD

Donation after brain death

Notes

Author’s contribution

Dr. Kohli collected and analyzed the data, reviewed literature and wrote the initial draft; Drs. Harrison, Fukami, Faigel and Pannala performed ERCP procedures and edited the manuscript; Dr. Moss edited the manuscript and provided critical inputs, Drs. Adike and El Kurdi collected data, Dr. Aqel analyzed the data, revised the manuscript and served as principal investigator for the study.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest to report.

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Divyanshoo R. Kohli
    • 1
    • 2
    Email author
  • M. Edwyn Harrison
    • 1
  • Abimbola O. Adike
    • 1
  • Bara El Kurdi
    • 1
  • Norio Fukami
    • 1
  • Douglas O. Faigel
    • 1
  • Rahul Pannala
    • 1
  • Adyr A. Moss
    • 3
  • Bashar A. Aqel
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicPhoenixUSA
  2. 2.Division of Gastroenterology and HepatologyKansas City VA Medical CenterKansas CityUSA
  3. 3.Department of SurgeryMayo ClinicPhoenixUSA

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