Biliary complications after liver transplantation from donation after XXXX donors: an analysis of risk factors and long-term outcomes from a single center.

@entity1 @entity63 @entity1620 @entity253 @entity204
OBJECTIVE: This study evaluates the long-term outcomes, biliary complication rates, and risk factors for @entity253 after liver transplantation from "donation after @entity204 " (DCD) donors. BACKGROUND: Recent enthusiasm toward increased use of DCD donors' livers is mitigated by high biliary complication rates. Predictive risk factors for the development of @entity253 after DCD liver transplantation remain incompletely defined. METHODS: We performed a retrospective review of 1157 "donation after @entity1620 " (DBD) and 87 DCD liver transplants performed between January 1, 1993, and December 31, 2008. @entity1 and graft survivals and complication rates within the first year of transplantation were compared between DBD and DCD groups. Cox proportional hazards models were used to assess the influence of potential risk factors. RESULTS: @entity1 survival was significantly lower in the DCD group compared with the DBD group at 1, 5, 10, and 15 years (DCD: 84%, 68%, 54%, and 54% vs DBD: 91%, 81%, 67%, and 58%; P < 0.01). Graft survival was also significantly lower in the DCD group compared with the DBD group at 1, 5, 10, and 15 years (DCD: 69%, 56%, 43%, 43% vs DBD: 86%, 76%, 60%, 51%; P < 0.001). Rates of overall @entity253 (OBC) (DCD: 47% vs DBD: 26%; P < 0.01) and @entity63 ( @entity63 ) (DCD: 34% vs DBD: 1%; P < 0.01) were significantly higher in the DCD group. Donor age [hazard ratio (HR): 1.04; P < 0.01] and donor age greater than 40 years (HR: 3.13; P < 0.01) were significant risk factors for the development of OBC. Multivariate analysis revealed that @entity63 ( @entity63 ) greater than 8 hours (HR: 2.46; P = 0.05) and donor age greater than 40 years (HR: 2.90; P < 0.01) significantly increased the risk of @entity63 . CONCLUSIONS: Long-term @entity1 and graft survival after DCD liver transplantation remain significantly lower but acceptable when compared with DBD liver transplantations. Donor age and @entity63 greater than 8 hours are the strongest predictors for the development of @entity63 . Careful selection of younger DCD donors and minimization of @entity63 may limit the incidence of severe @entity253 and improve the successful utilization of DCD donors' livers.
