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Liver transplant after circulatory death a viable option in PSC

Transplantation with donation after circulatory death in patients with primary sclerosing cholangitis did not impact graft loss or patient survival compared with donations after brainstem death, according to results of a recently published study.

“[Donation after circulatory death] livers are still used prudently, given the risk of acute kidney injury (AKI) and ischaemic type biliary lesions (ITBL),” Palak J. Trivedi, BSc, MBBS, MRCP, from the Institute of Immunology and Immunotherapy at the University of Birmingham, U.K., and colleagues wrote. “Given that the incidence of PSC is rising, while the prevalence of an ‘ideal’ donation pool continues to decline, the usage of liver grafts arising from [donation after circulator death] donors seems unavoidable in clinical practice.”

The researchers reviewed prospectively collected data of 143 patients with PSC who underwent transplantation with either livers donated after brainstem death (DBD) or donated after circulatory death (DCD). Thirty-five patients received DCD liver transplants. Characteristics were similar between both groups of patients.

Median age at time of transplant was 49 years (range, 35-60 years), 71.3% were men and 70.6% had history of inflammatory bowel disease.

Thirty-five patients developed a vascular complication after transplantation. In this group, there was a higher risk among the full-graft DCD recipients compared with both split DBD grafts (HR = 1.77; 95% CI, 0.88-3.57) and full DBD grafts (HR = 2.52; 95% CI, 1.16-5.46).

While there was a greater incidence of ischemic-type biliary lesions among the DCD recipients, the overall risk for developing biliary strictures after transplantation was not significantly different between the two groups. Further, the number of patients who needed intervention was also not significantly different between groups.

Data showed no significant differences between groups for median duration of surgery, transfusion requirements, duration of ICU stay or duration of hospital stay in total, development of hepatic artery thrombosis or recurrent biliary strictures, or event-free survival at 6 and 12 months.

Researchers also observed no significant differences between the groups for graft or patient survival times. Specifically, the DCD recipients had no increased risk for graft loss (HR = 1.69; 95% CI, 0.58-4.95), mortality risk (HR = 0.75; 95% CI, 0.25-2.21) or graft loss/mortality as a combined endpoint (HR = 1.24; 95% CI, 0.56-2.66) compared with the DBD recipients.

“The frequency of post-transplant biliary strictures in PSC does not significantly differ between donor types, although DCD recipients are more prone to early, ischaemic-type biliary lesions,” the researchers wrote. “However, overall patient and graft survival rates are not significantly different between PSC-DCD and PSC-DBD groups. Given the era of organ shortage, DCD liver transplantation represents a viable life-extending intervention in an appropriately selected patient population.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.