Complications Vascular And Biliary Post Liver Transplantation By Citizen's Donation After Death

Purpose: To evaluate complications post-liver transplanted from citizen's donation after death(CDD).Methods: This study examined retrospectively the data from our institution from June 2010 to June 2018.All data from our institution were evaluated including adult patients who underwent the first liver transplantation(LT)from June 2010 to June 2018.Clinical and demographic characteristics among liver transplant recipients were classified into two groups: DCD and DBD grafts.Overall postoperative complications focused on complications post-liver transplantation to the recipient were analyzed using those previous groups.Multiple organ transplants,pediatric liver transplants,and retransplantation were excluded.We complement the research in doing the Meta-analysis and integrating the results of the retrospective study on it.At the end of our study,we analyzed the Tcells function and infections post-liver transplantation with immunosuppression drugs.Potentially relevant articles published in English were collected by Pub Med and Medline published from 2012 to 2017.Biliary and vascular complications from adult patients receiving their first CDD LT were enclosed.This study was conducted using SPSS and Review Manager Version 5.2(Cochrane Collaboration,Copenhagen,Denmark)and the quality of the study was assessed using the Newcastle-Ottawa scale.Results: In our retrospective study,from June 2010 to June 2018,759 organ donations during those periods,502 grafts were retrospectively performed in our study,412(82.07%)from DBD and 90(17,93%)from DCD.DBD has undergone a long period of donor repair,maintenance,and corresponding pretreatment,so the curative effect is better than DCD.Timely and correct treatment of biliary complications and vascular complications does not affect the short-term efficacy.Rejection,primary disease,biliary complications,microbial infection,acute kidney injury,and liver and kidney syndrome are the main factors that affect the long-term efficacy.10 studies met our inclusion criteria in our meta-analysis.Heterogeneity in Donations after cardiac death(DCD)and donations after brain death(DBD)recipients were observed and minimized after a subgroup analysis was pooled.This latter analysis targeted biliary stricture,biliary leaks and stones,and vascular thrombosis and stenosis.Meta-analysis showed that patients receiving DCD organs have a great inflated risk of biliary complications than those receiving DBD organs,significantly the following: biliary leaks and stones(odds ratio [OR] =confidence interval 1.72,95 % [CI] 1.26-2.34);and biliary stricture(OR = 1.64,95% CI= 1.27-2.12).DCD grafts cared-for,however,were not considered related to DBD concerning vascular thrombosis(OR = 1.64,95% CI= 1.13-2.38),and also the risk of vascular stenosis in DCD grafts was not statistically significant(OR = 1.20,95% CI= 0.70-2.07).In T cell functions and infection post-liver transplantation with immune suppressive drugs,we found that the long-term immune suppression exposed the side effect of our patient.A high dose of immunosuppression led to a high risk of infection.In our retrospective study,more complications related to infection were observed.The results of stimulated lymphocyte function were results of phenotype analysis;the proportion of IFN-?–producing CD4+ T cells in extremely severe patients was much higher than in both mild and severe patients.The percentage of IFN-?–producing CD8+ T cells had no difference between severe and extremely severe illness patients.Regulatory T cells(Tregs)are essential for maintaining self-tolerance and preventing autoimmune disease.conclusion: There was no important difference between DCD and DBD recipients in long terms outcomes.Good organ procurement and early diagnosis of post LT complication with an immediate therapeutic approach lead to great outcomes for the patients although DCD is associated with an inflated risk of complication post-liver transplantation.To ensure the success of the transplant and the follow-up of the patient,the immunosuppression must be sufficient to prevent the rejection of the graft,without being toxic,and it is necessary to have recourse to antimicrobial prophylaxis to prevent the infections.