Evaluation of in-hospital complications after liver transplantation with the comprehensive complication index: potential benefit of DCD grafts in post alcoholic cirrhosis?

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M. Kalisvaart, J.E. de Haan, W.G. Polak, B.E. Hansen, J.N.M Ijzermans, H.J. Metselaar, J. de Jonge

Chair(s): dr. Robert A. Pol, vaat-en transplantatiechirurg, UMC Groningen & dr. Wojaiech G. Polak, chirurg, Erasmus MC

Thursday 10 march 2016

10:00 - 10:10h at Zaal 5 & 6

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie VIII - Klinisch chirurgisch en acuut

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Introduction:
DCD grafts are increasingly used in liver transplantation (LT) to overcome the donor shortage. These grafts are associated with more severe hepatic ischemia/reperfusion injury (IRI) and biliary complications. Due to the lack of appropriate morbidity parameters, short term recipient outcomes are still unknown. With the recently developed Comprehensive Complication Index (CCI) the postoperative morbidity after DCD LT can be compared with DBD LT.

Methods:
All consecutive patients (excluding retransplantations and high urgency LT) who underwent LT from January 2007 until August 2015 in our center were retrospectively assessed. In-hospital complications were registered by the Clavien Dindo classification. The CCI is the cumulative result of all complications weighted by their grade in this classification. Retransplantation was scored as a IVb complication. The postoperative peak serum AST was used to quantify hepatic IRI.

Results:
330 recipients were included of whom 98 (30%) received a DCD graft and 232 (70%) a DBD graft. Recipient age (p=0.059), labMELD (p=0.536), and BMI (p=0.149) were comparable for both graft types. Hepatic IRI was more severe in the DCD group (median peak AST 2827 vs. 929 U/L; p=0.001) and the in-hospital retransplantation rate was higher in this group as well (9% vs. 3%; p=0.024). However, the median CCI at hospital discharge was comparable for both graft types (DCD 38.7; DBD 36.2; p=0.537). To compare the CCI for different indications for LT (viral hepatitis, biliary cirrhosis, post alcoholic cirrhosis, and ‘other’ group), a sub-analysis was performed. This analysis showed a comparable median CCI for DCD and DBD grafts in the viral hepatitis (p=0.538), biliary cirrhosis (p=0.537), and ‘other’ (p=0.353) group. In recipients with post alcoholic cirrhosis (n=59) a lower median CCI was observed when DCD grafts were used (30.2 vs. 43.6; p=0.031), while DCD and DBD recipients in this subgroup had comparable age (p=0.619), labMELD (p=0.828), and BMI (p=0.478).

Conclusion:
This study provides new insight in the direct postoperative complications after LT. Despite more severe hepatic IRI and a higher retransplantation rate, the overall CCI was comparable in DCD and DBD LT. The lower CCI observed in DCD recipients with post alcoholic cirrhosis might have detected a subgroup suitable as recipients for DCD grafts.