Use of Tissue Plasminogen Activator (TPA) in Liver Transplantation from Donation After Cardiac Death (DCD) Donors: A Controlled Randomized Trial

B. Eghtesad, K. Hashimoto, M. Watson, M. Nazzal, C. Quintini, D. Kelly, T. Diago, N. Kawamura, G. El-Gazzaz, M. Fujiki, F. Aucejo, C. Winans, C. Miller, J. Fung.

Hepatobiliary and Liver Transplant Surgery, Cleveland Clinic, Cleveland, OH.

Meeting: 2015 American Transplant Congress

Abstract number: 275

Keywords: Bile duct, Donors, Graft function, Liver transplantation, non-heart-beating

Session Information

Session Name: Concurrent Session: Donor and Recipient Optimization for Liver Transplant

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 5:12pm-5:24pm

Location: Room 115-AB

To further evaluate the impact of tPA in reduction of ITBS in livers recovered from the DCD donors we conducted a controlled randomized trial. Between 2010 and 2013, 23 recipients of livers from DCD donors were enrolled (12 no tPA, and 11 tPA). During the same period another 57 recipients of livers from DCD donors (22 no tPA, and 35 tPA) were transplanted. All patients were followed for minimum 12 months. The donor and recipients age, MELD score, warm and cold ischemia time in all groups (Table 1) were similar. ITBS was seen in two patients; one no tPA in randomized group, and one in tPA nonrandomized recipients and both were retransplanted.

Four livers developed PNF (1 tPA, and 3 no tPA) and one liver in no tPA group developed hepatic artery stenosis leading to re-transplantation. Early complications (PNF, HAS, TIBS) happened in 2/46 (4.3%) in tPA, and 5/34 (14.7%) in no tPA group

TABLE 1: parameters affecting graft function in livers recovered from DCD donors between the four groups
	Number	Age at Tx	MELD score	Donor age	Warm ischemia time	Cold ischemia time
TPA protocol	11	61.8 +/- 5.9	22 +/- 5	33 +/- 14	21 +/- 7	389 +/- 36
No TPA protocol	12	56 +/- 11	23 +/- 5	40 +/- 13	23 +/- 4	373 +/- 76
TPA Nonprotocol	35	56 +/- 9	22 +/- 7	42 +/- 14	24 +/- 7	387 +/- 68
No TPA Nonprotocol	22	56 +/- 11	23 +/- 6	37 +/- 13	25 +/- 7	389 +/- 107

Conclusion: While the incidence of ITBS and other complications (PNF, HAT) in the non-tPA group was lower than earlier reported estimates (50%) thus limiting the power of comparison, these findings suggest that the reduction in these complications in the tPA group may be related to tPA use, in addition to other factors, such as limiting cold and warm ischemia times when using DCD livers.

To cite this abstract in AMA style:

Eghtesad B, Hashimoto K, Watson M, Nazzal M, Quintini C, Kelly D, Diago T, Kawamura N, El-Gazzaz G, Fujiki M, Aucejo F, Winans C, Miller C, Fung J. Use of Tissue Plasminogen Activator (TPA) in Liver Transplantation from Donation After Cardiac Death (DCD) Donors: A Controlled Randomized Trial [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-tissue-plasminogen-activator-tpa-in-liver-transplantation-from-donation-after-cardiac-death-dcd-donors-a-controlled-randomized-trial/. Accessed May 19, 2025.

« Back to 2015 American Transplant Congress