Donor blood composition is a risk factor for biliary injury in donation after circulatory death liver transplantation
O.B. van Leeuwen, M. van Reeven, D. van der Helm, J.N.M. IJzermans, I.P.J. Alwayn, B. van Hoek, W.G. Polak, T. Lisman, V.E. de Meijer, R.J. Porte
Thursday 5 march 2020
13:40 - 13:50h
at Theaterzaal
Parallel session: Parallel sessie XII – Klinische en Basale abstracts
Background: Post-transplant cholangiopathy following ischemia-reperfusion injury severely inhibits widespread application of donation after circulatory death liver transplantation (DCD-LT). Platelets and red blood cells are known to influence ischemia-reperfusion injury. We hypothesized that the platelet count and hematocrit of the DCD donor would influence biliary injury during DCD-LT. To study all cellular blood components, we also analyzed the influence of the donor leukocyte count on biliary injury.
Methods: First, the influence of platelet and leukocyte counts and hematocrit on bile duct histology prior to and bile composition during (pre)clinical normothermic machine perfusion (NMP) was assessed. Secondly, in a nationwide retrospective study, all adult DCD-LT between 2010-2017 were included to assess the influence of platelet and leukocyte counts and hematocrit on the development of non-anastomotic biliary strictures (NAS). Multivariate Cox Proportional-Hazards regression analyses were used to assess the influence of platelet and leukocyte counts and hematocrit on NAS.
Results: Analysis of bile duct biopsies of 40 NMP procedures revealed a significant impact of donor platelets (OR 2.553, 95% CI 1.082-6.021, p = 0.029) and leukocytes (0.734 95% CI 0.581-0.927, p = 0.009) on bile duct injury. Donor platelets also influenced biliary bicarbonate and pH levels during NMP. In the retrospective study, a total of 235 DCD-LT were included. In a multivariate Cox regression analysis, donor platelets (HR 1.047 95% CI 1.007-1.089, p = 0.022) and hematocrit (HR 1.044 95% CI 1.005-1.083, p = 0.025) were identified as significant independent risk factors for the development of NAS after DCD-LT.
Conclusions: Donor platelets and leukocytes significantly influence histological bile duct injury. Platelets influenced bicarbonate secretion and bile pH during NMP. Additionally, platelet count and hematocrit are significant independent risk factors for the development of NAS after DCD-LT.
