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Room: E-Poster Hall

P-4.07 Histopatological grade of ischemia reperfusion injury on short- and long-term outcomes in liver transplantation using DCD (deceased after circulatory death donor) grafts

Annalisa Dolcet, United Kingdom

Senior Clinical Fellow
Liver Institute
King's College Hospital

Abstract

Histopatological grade of ischemia reperfusion injury on short- and long-term outcomes in liver transplantation using DCD (deceased after circulatory death donor) grafts

Annalisa Dolcet1, Wayel Jassem1, Nigel Heaton1, Yoh Zen1.

1Liver Institute, King's College Hospital, London, United Kingdom

Objectives: To assess the impact of ischemia reperfusion injury (IRI) on DCD outcomes in liver transplantation.
Methods: Between 2002-2017, 455 DCD transplant were performed at our institution, of which 248 had post reperfusion biopsy that were graded for IRI into four categories (0-no necrotic hepatocytes, 1-scattered foci of single cell necrosis/ drop-out, 2-perivenular zonal necrosis, 3-broader necrosis).
Results: Grade 0, 1, 2 and 3 were 20.7%, 44.5%, 23.4% and 11.3% respectively.  In univariate analysis, grade 3 was significantly associated with donor functional warm ischemia>30 minutes (p= 0.036) and donor bilirubin>30 mmol/l (p= 0.014). IRI grade was also associated with MELD>20 (p=0.024), recipient coagulopathy (INR>2, PLT<70, p=0.011) and portal vein reperfusion, rather than artery (p=0.012).
Patient and graft survival were significantly associated with the grade of IRI (p=0.05). Patient survival at 1, 5, 10 years was: grade 0= 97.5, 94.7, 72.2 %; grade 1= 96.0, 78.6, 69.1%, grade 2= 91.2,79.8,67.1 %, and grade 3= 82.8, 77.6, 57.7 %.  Similarly graft survival at 1, 5, 10 years were in group 0 97.8, 94.3, 80.9%, group 1 94.9, 84.3, 72.4 %, group 2 91.2, 83.0, 73.4 %, and group 3 83.1, 73.3,68.6 %, respectively.
The incidence of PNF, HAT and re-transplantation was not associated with the grade of IRI. Patient with IRI had higher rates of re-laparotomies for bleeding (p=0.016) and higher peak AST in the first seven postoperative days (p=0.013). However, no association was observed between IRI and early allograft dysfunction, biliary complications, grade of rejection, viral and malignant recurrence post-transplant.
Conclusion: IRI is an independent risk factor for graft and patient survival. The exact reasons for this are unclear. This grading system might be of use to predict outcome post-liver transplantation. Efforts to minimize IRI are important at a time of organ shortage and increasing use of marginal grafts.

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