Jimenez-Romero C, Justo-Alonso I, del Pozo-Elso P, Marcacuzco-Quinto A, Martín-Arriscado-Arroba C, Manrique-Municio A, Calvo-Pulido J, García-Sesma A, San Román R, Caso-Maestro O. Post-transplant biliary complications using liver grafts from deceased donors older than 70 years: Retrospective case-control study. World J Gastrointest Surg 2023; 15(8): 1615-1628 [PMID: 37701699 DOI: 10.4240/wjgs.v15.i8.1615]
Corresponding Author of This Article
Oscar Caso-Maestro, MD, PhD, Associate Professor, Surgeon, Unit of HBP Surgery and Abdominal Organs Transplantation, ‘12 de Octubre’ University Hospital, Av. Córdoba s/n, Madrid 28041, Spain. oscarcasomaestro@hotmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1615-1628 Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1615
Post-transplant biliary complications using liver grafts from deceased donors older than 70 years: Retrospective case-control study
Carlos Jimenez-Romero, Iago Justo-Alonso, Pilar del Pozo-Elso, Alberto Marcacuzco-Quinto, Cristina Martín-Arriscado-Arroba, Alejandro Manrique-Municio, Jorge Calvo-Pulido, Alvaro García-Sesma, Ricardo San Román, Oscar Caso-Maestro
Carlos Jimenez-Romero, Iago Justo-Alonso, Pilar del Pozo-Elso, Alberto Marcacuzco-Quinto, Alejandro Manrique-Municio, Jorge Calvo-Pulido, Alvaro García-Sesma, Oscar Caso-Maestro, Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
Cristina Martín-Arriscado-Arroba, Clinical Research Unit (I+12), `12 de Octubre´ University Hospital, Madrid 28041, Spain
Ricardo San Román, Department of Radiology, `12 de Octubre´ University Hospital, Madrid 28041, Spain
Author contributions: Jimenez-Romero C and Caso-Maestro O designed the research and wrote the paper; Jimenez-Romero C, Justo-Alonso I, san Román R and Caso-Maestro O analyzed data; Justo-Alonso I, del Pozo-Elso P, Marcacuzco-Quinto A, Manrique-Municio A, Calvo-Pulido J and García-Sesma A collected data; Martín-Arriscado-Arroba C peformed the statistical analysis.
Institutional review board statement: The study was reviewed and approved by the `12 de Octubre´ University Hospital Institution Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were collected after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset is available from the corresponding author if required.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oscar Caso-Maestro, MD, PhD, Associate Professor, Surgeon, Unit of HBP Surgery and Abdominal Organs Transplantation, ‘12 de Octubre’ University Hospital, Av. Córdoba s/n, Madrid 28041, Spain. oscarcasomaestro@hotmail.com
Received: January 19, 2023 Peer-review started: January 19, 2023 First decision: March 14, 2023 Revised: March 27, 2023 Accepted: June 25, 2023 Article in press: June 25, 2023 Published online: August 27, 2023 Processing time: 217 Days and 16.6 Hours
Abstract
BACKGROUND
The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.
AIM
To determine the incidence, outcomes, and risk factors for biliary complications (BC) in liver transplantation (LT) using liver grafts from donors aged > 70 years.
METHODS
Between January 1994 and December 31, 2019, 297 LTs were performed using donors older than 70 years. After excluding 47 LT for several reasons, we divided 250 LTs into two groups, namely post-LT BC (n = 21) and without BC (n = 229). This retrospective case-control study compared both groups.
RESULTS
Choledocho-choledochostomy without T-tube was the most frequent technique (76.2% in the BC group vs 92.6% in the non-BC group). Twenty-one patients (8.4%) developed BC (13 anastomotic strictures, 7 biliary leakages, and 1 non-anastomotic biliary stricture). Nine patients underwent percutaneous balloon dilation and nine required a Roux-en-Y hepaticojejunostomy because of dilation failure. The incidence of post-LT complications (graft dysfunction, rejection, renal failure, and non-BC reoperations) was similar in both groups. There were no significant differences in the patient and graft survival between the groups. Moreover, only three deaths were attributed to BC. While female donors were protective factors for BC, donor cardiac arrest was a risk factor.
CONCLUSION
The incidence of BC was relatively low on using liver grafts > 70 years. It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy, without significant differences in the patient or graft survival between the groups.
Core Tip: The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors. Some authors have proposed a higher incidence of biliary complications (BC) using advanced age donors. In our experience, the incidence of BC was low on using liver grafts > 70 year (8.4%). Patient and graft survival were similar to patients without biliary complications and most of them could be managed by percutaneous dilation or Roux-en-Y hepaticojejunostomy.
