Background: Formation of microthrombi within the peribiliary arterial plexus causing necrosis of biliary epithelium may be responsible for ischemic cholangiopathy (IC) after donation after circulatory death (DCD) liver transplantation. To prevent IC in DCD liver transplants, we incorporated thrombolytic aortic flush using tissue-plasminogen activator (TPA) prior to cold preservation. Methods: 82 liver transplants from DCD donors were performed from 2004 to 2014 at our institute. In most recent 21 cases, 100 mg TPA was reconstituted in 1 liter normal saline at room temperature and flushed through the aortic cannula immediately after aortic cross-clamping. This was followed by 3-4 liters of cold preservative flush, topical cooling and 500 ml portal flush on the back-table. Liver transplants were performed using piggyback technique and arterial anastomoses were performed after portal re-perfusion. Donor and recipient characteristics are described in Table-1. Results: 9 (11%) patients developed IC. Of these, 3 were re-transplanted successfully with deceased donor allografts and 6 died while being considered for re transplant. Early allograft dysfunction (EAD) was present in 35% cases, early acute kidney injury (AKI) was noted in 29% cases and 1-year graft survival was 82%. In patients receiving allografts that were flushed with TPA, none developed IC. TPA flush did not impact EAD, early AKI; and 1-year graft survival. Conclusion: Utilization of TPA flush at the time of procurement prevented IC completely in this series. It may be possible to expand the use of DCD livers for transplantation with the use of thrombolytic flush.

« Back to 2015 American Transplant Congress