Purpose Although important liver transplant outcomes, such as primary nonfunction, vascular thrombosis, and graft loss, are well reported for marginal grafts in the transplant literature, there are few reports of biliary complications in extended criteria donor (ECD) livers. This study compares ECD and standard donors (SD) for biliary complications in cadaveric, whole-organ liver transplantation.
Methods This study is a retrospective review of all liver transplants between 2001 and 2006, with an extensive review of all endoscopic and percutaneous biliary imaging. Our center uses biliary imaging as first evaluation for elevated liver enzymes, prior to biopsy. Outcomes included need for imaging, leak requiring reoperation, intrahepatic strictures, presence of stones or gravel, and first 30-day liver function tests (AST, ALT, alkaline phosphatase, total bilirubin).
Results There were 698 orthotopic transplants, including 593 with choledochocholedochostomy (CDC) and 100 Roux-Y reconstructions (RYHJ) (5 OR deaths). Results are presented in the Table. SD and ECD livers do not differ significantly in requirement for biliary imaging, occurrence of biliary leak, or intrahepatic strictures. ECD livers are more likely to have choledocholithiasis. Thirty-day liver enzymes are statistically equivalent.
Conclusion ECD livers have been used extensively at our center to decrease median wait time to less than 30 days, with very few wait list deaths and improved post-transplant survival. Results of this analysis demonstrate no increased risk for biliary complications in patients receiving ECD livers.
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