High peak alanine aminotransferase determines extra risk for nonanastomotic biliary strictures after liver transplantation with donation after circulatory death.

Orthotopic liver transplantation ( OLT) with donation after circulatory death ( DCD) often leads to a higher first week peak alanine aminotransferase ( ALT) and a higher rate of biliary nonanastomotic strictures ( NAS) as compared to donation after brain death ( DBD). This retrospective study was to evaluate whether an association exists between peak ALT and the development of NAS in OLT with livers from DBD ( n = 399) or DCD ( n = 97) from two transplantation centers. Optimal cutoff value of peak ALT for risk of development of NAS post- DCD- OLT was 1300 IU/l. The 4-year cumulative incidence of NAS after DCD- OLT was 49.5% in patients with a high ALT peak post- OLT, compared with 11.3% in patients with a low ALT peak. ( P < 0.001). No relation between peak ALT and NAS was observed after DBD- OLT. Multivariate analysis revealed peak ALT ≥1300 IU/l [adjusted hazard ratio ( aHR) = 3.71, confidence interval ( CI) (1.26-10.91)] and donor age [ aHR = 1.04, CI 1.00-1.07] to be independently associated with development of NAS post- DCD- OLT. A peak ALT of <1300 IU/l carries a risk for NAS similar to DBD- OLT. Thus, in DCD- OLT, but not in DBD- OLT, peak ALT discriminates patients at high or low risk for NAS. [ABSTRACT FROM AUTHOR]