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Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors
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International audience. We read with great interest the study of Ghinolfi et al. entitled: “Risk Analysis of Ischemic-Type Biliary Lesions After Liver Transplant using Octogenarian Donor”. The authors reported their series of 123 liver transplantations (LT), performed with the retro-hepatic inferior vena cava (IVC) replacement technique and veno-venous bypass, using octogenarian grafts and found that donor hemodynamic instability, diabetes mellitus and D-MELD were predictive of higher incidence of ischemic-type biliary lesions (ITBL) incidence in multivariate analysis. In our center, we routinely perform LT with retro-hepatic IVC preservation and side-to-side cavo-caval anastomosis. According to surgeon preference, a temporary porto-caval shunt (TPCS) is performed or not. Since January 2007 to December 2014, 816 transplantations were performed in our institution and, using the same selection criteria as Ghinolfi et al., we identified 48 LT performed using octogenarian donors. TPCS was performed in 31 cases and absent in 17 cases. We found that octogenarian graft survival was significantly improved when a TPCS was performed (p=0.02) (figure 1-A). We also observed a significant reduction of alkaline phosphatase and gamma-glutamyl transferase level in the early postoperative days (POD), while bilirubin levels were similar.
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