Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2016; 22(12): 3392-3403
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3392
Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy
Thomas J Chirichella, C Michael Dunham, Michael A Zimmerman, Elise M Phelan, M Susan Mandell, Kendra D Conzen, Stephen E Kelley, Trevor L Nydam, Thomas E Bak, Igal Kam, Michael E Wachs
Thomas J Chirichella, Elise M Phelan, Kendra D Conzen, Trevor L Nydam, Thomas E Bak, Igal Kam, Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora, CO 80045, United States
C Michael Dunham, Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, OH 44501, United States
Michael A Zimmerman, Department of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
M Susan Mandell, Department of Anesthesiology, University of Colorado, Aurora, CO 80045, United States
Stephen E Kelley, Donor Alliance Organ Procurement Organization, Denver, CO 80045, United States
Michael E Wachs, Department of Transplant Surgery, Children’s Hospital Colorado, Aurora, CO 80045, United States
Author contributions: Chirichella TJ, Dunham CM, Zimmerman MA, Kam I and Wachs ME conceived and designed the study; Chirichella TJ, Dunham CM, Zimmerman MA, Phelan EM, Mandell MS, Kelley SE, Nydam TL, Bak TE, Kam I and Wachs ME performed the research; Chirichella TJ and Phelan EM acquired the data; Chirichella TJ, Dunham CM, Zimmerman MA, Phelan EM, Mandell MS, Conzen KD, Kelley SE, Nydam TL, Bak TE, Kam I and Wachs ME analysed and interpreted the data; Chirichella TJ, Dunham CM, Mandell MS and Wachs ME drafted the article or revised it critically for important intellectual content.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: Technical appendix and dataset are available from the corresponding author at tchirichella@gmail.com, after a signed data user agreement is obtained. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thomas J Chirichella, MD, Transplantation Fellow, Division of Transplant Surgery, 1635 Aurora Ct., 7th Floor, University of Colorado Hospital, Aurora, CO 80045, United States. tchirichella@gmail.com
Telephone: +1-720-8480878 Fax: +1-720-8480841
Received: May 3, 2015
Peer-review started: May 9, 2015
First decision: September 9, 2015
Revised: October 6, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: March 28, 2016
Processing time: 325 Days and 15.2 Hours
Core Tip

Core tip: Cholangiopathy is a common and devastating clinical complication developing in recipients following donation after circulatory death liver transplantation. Numerous published investigations have attempted to link the hemodynamic instability and hypoxemia following withdrawal of life support to the development of cholangiopathy, without success. Our research indicates that cholangiopathy is linked to the magnitude of hypoxemic, ischemic, and anemic hypoxia transpiring after life support withdrawal and can be represented by a donor hypoxia score. We recommend that the historically utilized nomenclature of ischemic cholangiopathy be replaced using a more physiologic-based and expansive term, hypoxic cholangiopathy.