14 days
Diffuse necrosis
Figure S 1 . Cholangiogram demonstrating diffuse necrosis pattern of ischemic
cholangiopathy 14 days following donation after circulatory death liver transplant.
5 days 14 days 36 days
Multifocal progressive
Multifocal strictures are visible
Progression of multifocal strictures Normal cholangiogram
Figure S 2 . Cholangiograms demonstrating m ultifocal p rogressive pattern of ischemic
cholangiopathy 5-, 14-, and 36-days following donation after circulatory death liver
transplant.
122 days
Confluence dominant
At the level of the hepatic hilum, the first generation bile ducts are strictured with fibrosis towards the common hepatic duct
Figure S 3 . Cholangiogram demonstrating confluence dominant pattern of ischemic
cholangiopathy 122 days following donation after circulatory death liver transplant.
21 days 210 days
Minor form
Mild irregularity in the peripheral ducts Mild irregularity in the peripheral ducts
Figure S 4 . Cholangiogram demonstrating m inor f orm p attern of ischemic cholangiopathy
21 and 210 days following donation after circulatory death liver transplant.
Data S1. Summary of Criteria: DCD donor criteria during the study period.
Mayo Clinic Florida (MCF)
Total Warm Time – Up to 40 minutes
Functional Warm time – Time from pulseless electrical activity (PEA) until cross clamp within 10 minutes Location of withdrawal – Prefer operating room (OR) but will accept postanesthesia care unit (PACU) Recovery Surgeon – All donors done by experienced attending surgeon from MCF (no exception) Flush Type – University of Wisconsin solution
Backtable Flush – Additional backtable flush until effluent devoid of blood for all donation after circulatory death (DCD) donors
Procurement - Super Rapid Technique with aim to cross clamp within 1-2 minutes from skin incision Visual appearance – Liver must have uniform flush
Donor age cutoff: 65 years (age consider among other factors such as steatosis when accepting any liver) Cold ischemic time – As short as possible, no cutoff
Mayo Clinic Arizona (MCA) Total Warm Time – Up to 30 minutes
Functional Warm time – Time from PEA until cross clamp within 10 minutes Location of withdrawal – Prefer OR but will accept PACU
Recovery Surgeon – Will let fellows do procurements and will accept DCDs procured by other centers if a relationship has been established with procuring surgeon
Flush Type – histidine-tryptophan-ketoglutarate (HTK) solution preferentially but willing to accept University of Wisconsin solution
Backtable Flush – Not routinely done
Procurement - Super Rapid Technique with aim to cross clamp within 1-2 minutes from skin incision Visual appearance – Liver must have uniform flush
Donor age cutoff: 65 years (age consider among other risk factors such as steatosis when accepting any liver)
Cold ischemic time – As short as possible, no cutoff
Mayo Clinic Rochester (MCR) Total Warm Time – Up to 30 minutes
Functional Warm time – Time from PEA until cross clamp within 10 minutes Location of withdrawal – Prefer OR but will accept PACU
Recovery Surgeon – All donors done by attending surgeon from MCR (no exception) Flush Type – University of Wisconsin solution
Backtable Flush – Not routinely done
Procurement - Super Rapid Technique with aim to cross clamp within 1-2 minutes from skin incision Visual appearance – Liver must have uniform flush
Donor age cutoff: 50 years (age consider among other risk factors such as steatosis when accepting any liver)
Cold ischemic time – As short as possible, no cutoff