Background

Efforts to expand the donor pool have resulted in increased utilization of donation-after-cardiac-death (DCD) liver donors. Here we report on our experience using high dose tissue plasminogen activator (tPA) to flush the donor liver following cardiac death.

Methods

In 100 mL of sterile water 100mg of tPA is reconstituted and diluted in 1L of room-temperature normal saline. DCD procurement follows the standard protocol in which the donor is terminally extubated and given 30,000 units of intravenous heparin. After asystole and a 5-minute no-touch period, the aorta is emergently cannulated, and tPA infusion is begun with concomitant cross-clamping. Cold UW flush is continued after this initial infusion is completed. We performed 17 liver transplants this using this method.

Results

Mean recipient and donor age was 56 and 29 years respectively. Mean warm ischemic time was 30 minutes and mean cold ischemic time was 277 minutes. Eight patients had a MELD score without exception points, with a mean score of 19.3. Nine patients received exception points with a mean MELD score of 29. Overall graft and patient survival was 94% and 94%, respectively, with a mean follow-up time of 772 days. One patient developed a subclinical biliary stricture on imaging that did not require intervention. There was one death due to primary non-function, which was thought to be due to a macrosteatotic graft. One patient developed hepatic artery thrombosis. One patient had an episode of rejection 3 years post-transplant, successfully treated. Thirteen patients had no major post-operative complications.

Conclusions

We observed lower than expected rates of biliary ischemic cholangiopathy compared to published data, possibly due to high dose tPA given during DCD procurement. A larger multicenter study may prove this observation.

CITATION INFORMATION: Torabi J., Graham J., Bellmare S., Kinkhabwala M., Rocca J. High Dose Tissue Plasminogen Activator Flush during Donation-after-Cardiac-Death (DCD) Liver Procurements Offers Optimal Outcomes Am J Transplant. 2017;17 (suppl 3).

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