Use of thrombolytic streptokinase as a preflush in the NHBD procurement

Novel Short-term Hypothermic Oxygenated Perfusion (HOPE) System Prevents Injury in Rat Liver Graft From Non-Heart Beating Donor

“…Administration of streptokinase during the cold flush of the ischemic liver has been shown to improve microvascular perfusion and to reduce hepatocellular enzyme release in rat ex vivo reperfusion after warm ischemia. [25][26][27] Also, the use of low viscosity cold flush solutions (polysol, celsior) 28 -30 has led to lower vascular resistance and improved survival of NHBD livers if applied directly after harvest with minimal cold storage time. Oxygenation of the graft either by cold or warm machine perfusion or oxygen persufflation did successfully rescue warm or cold ischemically damaged livers if applied during the entire time of preservation.…”

Derivation of the Uncontrolled Donation after Circulatory Determination of Death Protocol for New York City

“…To prevent microvascular clotting, initiation of preservation with heparin infusion, chest compressions and assisted ventilation should occur ‘soon after death determination’. For livers, the director of NYU's transplantation service suggested thrombolytic infusion to improve graft function and survival (17–20). Normothermic extracorporeal membrane oxygenation (nECMO) was chosen as the preservation method for its protective and reparative properties (15,21,22).…”

Significance of microvascular thrombosis in renal allografts: role of ex vivo thrombolytic therapy

“…This pre‐flush was used later by Gok et al. (10) in 24 kidneys from non‐heart beating human donors subjected to machine perfusion, with 64.3% of streptokinase‐treated kidneys able to be used as opposed to 31.3% for the non‐streptokinase‐treated kidneys. Streptokinase also increased significantly the perfusion flow index from 0.55 mL/min/mmHg/100 g tissue to 0.63 mL/min/mmHg/100 g tissue.…”