Background: In early 2010, our center implemented a thrombolytic protocol for DCD liver transplantation in an effort to reduce biliary complications and improve graft survival. The protocol includes retrograde flush of the hepatic veins (backtable) and administration of tissue plasminogen activator (tPA) (2mg) and verapamil (5mg) into the donor hepatic artery immediately after portal reperfusion.

Methods: Retrospective review of 100 consecutive DCD liver transplants using tPA protocol.

Results: Recipient characteristics included median age 56.3 yrs [range 21-70.3 yrs], median body mass index (BMI) 27.9 kg/m2 [16.6-47.5], and median MELD score 22 [7-40]. Donor characteristics included median age 40 yrs [5-62], BMI 28.6 [19.4 – 49.6], peak donor AST 122 [17-1949] and ALT 87 [6-1268]. The dose of heparin administered to the donor prior to withdrawal varied from 30,000 units (N=73), 5-15,000 units (N=20) or none (N=7). Donors were from local (N=41), regional (N=49) or national (N=10) allocation. Median ischemia times included donor warm ischemia (extubation to flush) 23 min [9-56 min], cold ischemia time 4.8 hrs [2.6-9.7 hrs], and in situ warm ischemia (implantation) 28 min [17-51 min]. Median intra-op blood transfusion was 2 units PRBC [0-35]. Early allograft function was assessed by median peak AST 1607 [339-15872], ALT 571 [59-4932], INR (day 7) 1.1 [0.8-2.7], total serum bilirubin (day 7) 2.0 [0.4-19.2]. There were 2 hepatic artery thrombosis, 1 early requiring retransplantation and a second late thrombosis formed collaterals. Accelerated ultrasound surveillance identified 9 cases of hepatic artery stenosis treated endovascularly. Biliary complications occurred in 25 patients, including 7 leaks and 18 anastomotic strictures all successfully treated with endoscopic stent. We observed 4 cases of ischemic-type diffuse cholangiopathy: 1 in conjunction with HAT required retransplantion, 2 asymptomatic with improvement and 1 resolved. One and 3-year patient survival was 91.5 and 87.8% and graft survival 91.6 and 87.9%, respectively by log-rank analysis.

Conclusion: In conjunction with donor heparinization and minimization of cold ischemia time, a DCD liver protocol including tPA can result in satisfactory patient and graft survival with a low incidence of ischemic cholangiopathy.

CITATION INFORMATION: Seal J, Bohorquez H, Battula N, Ahmed E, Bruce D, Carmody I, Trevor R, Tyson G, Joshi S, Bzowej N, Therapondas G, Girgrah N, Cohen A, Loss G. Results from 100 Consecutive Donation-After-Circulatory Death (DCD) Liver Transplants Using a Thrombolytic Protocol. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress