Use of Tissue Plasminogen Activator in Liver Transplantation from Donation After Cardiac Death Donors

Hashimoto, Koji; Eghtesad, Bijan; Gunasekaran, Ganesh; Uso, Teresa Diago; Quintini, Cristiano; Aucejo, Federico; Kelly, D. G.; Winans, Charles; Vogt, David; Parker, Brian M.; Irefin, Samuel A.; Miller, Charles M.; Fung, John J.

doi:10.1111/j.1600-6143.2010.03337.x

Cited by 124 publications

(137 citation statements)

References 31 publications

(44 reference statements)

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“…During the additional period of WIT without organ preservation stasis and thrombus formation in small vessels is expedited (77). Since also the peribiliary plexus is involved, the incidence of biliary complications is almost doubled (78).…”

Section: Special Issues Of Dcdmentioning

confidence: 99%

“…Innovative approaches for lowering the biliary mobidity of DCD-LT include thrombolytic agents (83) or machine perfusion (84). First clinical results using backtable injection of tissue plasminogen activator (TPA) into the donor hepatic artery before DCD-LT revealed a low incidence of ischemic cholangiopathy of 9% and an overall biliary complication rate of 27%.…”

Section: Special Issues Of Dcdmentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

230

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Special Issues Of Dcdmentioning

confidence: 99%

Section: Special Issues Of Dcdmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

230

View full text Add to dashboard Cite

show abstract

“…Donor age, genetic predispositions (such as CCR5 delta 32), and the choice of preservation solution have also been discussed as additional risk factors [7][8][9][10] . Partial microthrombosis of the peribiliary vessels has been suggested as potential mechanism for ITBS after liver transplantation with DCD grafts 11 .…”

Section: Introductionmentioning

confidence: 99%

Technique of Subnormothermic <em>Ex Vivo</em> Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Knaak

Spetzler

Goldaracena

et al. 2014

JoVE

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The success of liver transplantation has resulted in a dramatic organ shortage. In most transplant regions 20-30% of patients on the waiting list for liver transplantation die without receiving an organ transplant or are delisted for disease progression. One strategy to increase the donor pool is the utilization of marginal grafts, such as fatty livers, grafts from older donors, or donation after cardiac death (DCD). The current preservation technique of cold static storage is only poorly tolerated by marginal livers resulting in significant organ damage. In addition, cold static organ storage does not allow graft assessment or repair prior to transplantation.These shortcomings of cold static preservation have triggered an interest in warm perfused organ preservation to reduce cold ischemic injury, assess liver grafts during preservation, and explore the opportunity to repair marginal livers prior to transplantation. The optimal pressure and flow conditions, perfusion temperature, composition of the perfusion solution and the need for an oxygen carrier has been controversial in the past.In spite of promising results in several animal studies, the complexity and the costs have prevented a broader clinical application so far. Recently, with enhanced technology and a better understanding of liver physiology during ex vivo perfusion the outcome of warm liver perfusion has improved and consistently good results can be achieved. This paper will provide information about liver retrieval, storage techniques, and isolated liver perfusion in pigs. We will illustrate a) the requirements to ensure sufficient oxygen supply to the organ, b) technical considerations about the perfusion machine and the perfusion solution, and c) biochemical aspects of isolated organs. Video LinkThe video component of this article can be found at

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“…Hashimoto et al [46] suggested that the higher incidence in biliary complications of DCD livers may be related to microthrombi in the peri-biliary plexus. In this study they included 22 patients and assessed the effect of tissue plasminogen activator (TPA) injected into the hepatic artery of donor's during back table.…”

Section: Thrombolytic Therapies (Tissue Plasminogen Activator)mentioning

confidence: 99%

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Mahboub¹,

Bozorgzadeh²,

Martins³

2016

WJT

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There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft's for transplantation, improve the outcomes, and decrease the mortality on the waiting list. Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6(2): 314320 Available from: URL:

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Use of Tissue Plasminogen Activator in Liver Transplantation from Donation After Cardiac Death Donors

Cited by 124 publications

References 31 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Technique of Subnormothermic <em>Ex Vivo</em> Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

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