Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multi-Center IDOL Consortium.

Background: In the US, 5% of adult liver transplant recipients receive a graft donated after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes. Methods: Retrospective de-identified data collected between 2005 and 2013 were entered electronically by 10 centers via a REDCap database. Our primary outcome was development of intra-hepatic biliary strictures consistent with IC. Results: Within 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intra-hepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (p=0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (versus duct-to-duct), OR: 3.06, 95% CI: 1.52-6.16, p=0.002. Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (OR for IC: 3.36, 95% CI: 1.95-5.79). Conclusions: This first report of the large combined experience with DCDD from the IDOL consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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