TY - JOUR
T1 - Liver allograft findings of donation after cardiac death versus brain death in recipients with hepatitis C related cirrhosis
T2 - a matched histologic comparison
AU - Byrnes, Kathleen
AU - Vachharajani, Neeta
AU - Doyle, Maria M.
AU - Nalbantoglu, ILKe L.K.
N1 - Funding Information:
Funding/Support: No funding was used for this research.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - As the demand for organ transplantation increases, utilization of liver allografts of donation after cardiac death (DCD) is becoming increasingly necessary. Although the clinical outcomes of DCD allografts have been well described, the histologic features are not well characterized. Liver biopsies (n = 131) from age-matched DCD (n = 60) and donation after brain death (DBD; n = 71) recipients with hepatitis C virus were compared. Histologic features were studied in a blinded fashion, subgrouped into time 0, 0–6 months, and >6 months. In time 0 biopsies, more DCD cases had zone 3 (43.8 vs 29%) and bridging necrosis (19 vs 0%), albeit not statistically significant. At 0–6 months, more DCD cases had portal edema (p = 0.01). Pericholangitis (30.4% vs 18.8%) and acute cholestasis (21.7% vs 12.5%) were more common in DCD, but not statistically significant. At >6 months, pericholangitis (19% vs 4.5%) persisted in DCD, although not statistically significant. Overall, both groups had similar bile duct injury, portal inflammation, and fibrosis. Postoperative biliary complications were more common in DCD (19% vs 0%). Three-year and 10-year graft survival and patient outcomes were similar in both cohorts. Biliary alterations were more prevalent in the 0–6 month time period DCD biopsies, reflecting increased vulnerability of this group to biliary complications in the early post-orthotopic liver transplant (OLT) period. This finding may suggest poor graft perfusion despite comparable cold ischemia times. However, these features improved and DCD recipients have similar graft and overall survival compared to DBD recipients, indicating that carefully selected DCD liver allografts are a viable option for transplantation.
AB - As the demand for organ transplantation increases, utilization of liver allografts of donation after cardiac death (DCD) is becoming increasingly necessary. Although the clinical outcomes of DCD allografts have been well described, the histologic features are not well characterized. Liver biopsies (n = 131) from age-matched DCD (n = 60) and donation after brain death (DBD; n = 71) recipients with hepatitis C virus were compared. Histologic features were studied in a blinded fashion, subgrouped into time 0, 0–6 months, and >6 months. In time 0 biopsies, more DCD cases had zone 3 (43.8 vs 29%) and bridging necrosis (19 vs 0%), albeit not statistically significant. At 0–6 months, more DCD cases had portal edema (p = 0.01). Pericholangitis (30.4% vs 18.8%) and acute cholestasis (21.7% vs 12.5%) were more common in DCD, but not statistically significant. At >6 months, pericholangitis (19% vs 4.5%) persisted in DCD, although not statistically significant. Overall, both groups had similar bile duct injury, portal inflammation, and fibrosis. Postoperative biliary complications were more common in DCD (19% vs 0%). Three-year and 10-year graft survival and patient outcomes were similar in both cohorts. Biliary alterations were more prevalent in the 0–6 month time period DCD biopsies, reflecting increased vulnerability of this group to biliary complications in the early post-orthotopic liver transplant (OLT) period. This finding may suggest poor graft perfusion despite comparable cold ischemia times. However, these features improved and DCD recipients have similar graft and overall survival compared to DBD recipients, indicating that carefully selected DCD liver allografts are a viable option for transplantation.
KW - Donation after cardiac death
KW - Graft survival
KW - Ischemia
KW - Liver
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=85125135660&partnerID=8YFLogxK
U2 - 10.1016/j.humpath.2022.01.005
DO - 10.1016/j.humpath.2022.01.005
M3 - Article
C2 - 35085598
AN - SCOPUS:85125135660
SN - 0046-8177
VL - 122
SP - 25
EP - 31
JO - Human Pathology
JF - Human Pathology
ER -