Non-anastomotic biliary strictures after cDCD liver transplantation with normothermic regional perfusion An IDEAL-Stage 4 study with a prospective radiological follow-up

Retrospective studies showed a reduction of nonanastomotic strictures (NASs) after controlled donation after circulatory death (cDCD) liver transplantation using normothermic regional perfusion (NRP). In the absence of a randomized controlled trial, a systematic radiological follow-up of recipients is warranted to validate these findings. This single-center retrospective study (January 2015-January 2024) includes all consecutive cDCD liver transplantations performed after A-NRP at a single center. Recipients were included in a prospective radiological follow-up protocol with magnetic resonance cholangiopancreatography (MRCP) to identify NAS, which were defined as strictures of intrahepatic or extrahepatic bile ducts in the absence of arterial thrombosis. Seventy-one NRP cDCD liver transplantations were included in the study, of which 66 (93%) underwent a follow-up MRCP after a median of 180 days. We diagnosed 1 asymptomatic radiological NAS (1.4%) with minor severity (grade E) not requiring treatment. The rate of symptomatic anastomotic biliary complications was 30% (n = 21). After a median follow-up of 39 months, we recorded no graft loss related to biliary complications. One- and 5-year graft and recipient survival rates were 94.4% and 85.9%, and 95.8% and 84.6%, respectively. This single-center 10-year experience with A-NRP for cDCD liver transplantation and a prospective MRCP follow-up of recipients shows < 2% of NAS with no graft loss related to biliary complications.