Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a higher rate (up to 50%) of complications of ischemic cholangiopathy and a higher risk (up to 30%) of graft loss compared to donation after brain death (DBD) donor. It has been assumed that ischemic cholangiopathy is attributed by microthrombosis in peribiliary capillary resulting in biliary epithelial necrosis and sclerosis. Here we report preliminary outcome data using tissue plasminogen activator (tPA) in organ procurement from DCD donors. 100mg tPA reconstituted in 1 liter of room temperature normal saline was rapidly infused to aorta 3 minutes before cold flush. Warm ischemic time was up to 30 minutes. From 2013 to 2015, 18 DCD LT were performed in our center. Transfusion requirement were comparable with DBD LT. Only two patients developed biliary anastomotic stricture requiring stent placement by endoscopic retrograde cholangiopancreatography (ERCP). No patient developed diffusive intrahepatic cholangiopathy. Both patient and graft survival remain 100% at mean follow up of 357.6±240 days. Notably one ofDCD donors was five years old and the adult recipient continues to be cholangiopathy-free after 1 year postop. In conclusion, thrombolytic protocol in organ procurement from DCD donors reduces ischemic cholangiopathy in liver transplantation without requiring excessive blood transfusion. More data would be needed.

CITATION INFORMATION: Fan J, Selvaggi G, De Faria W, Nishida S, Tekin A, Beduschi T, Yushkov Y, Vianna R. Thrombolytic Protocol in Organ Procurement from Donation After Circulatory Death Donors Reduces Ischemic Cholangiopathy in Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress