Urokinase is safe but does not improve outcome of DCD liver transplantation

What is it about?

Liver transplantation (LT) with the use of a graft from a donor deceased due to circulatory death (DCD, also called 'non-heart-beating donors') is increasing. Although patient survival is similar to LT with a liver from a donor deceased with brain death (DBD), the incidence of non-anastomotic biliary strictures (NAS, also 'ischemic-type biliary strictures' or ITBL) is higher in DCD (up to 30%) than in DBD (up to 10%) liver transplantation. Also primary non-function (PNF) and initial poor function (IPF) incidences are higher in DCD than in DBD LT in some publications. There are some publications claiming that NAS/ITBL and PNF and IPF are less frequent if the liver is perfused with a thrombolytic agent before implantation. Most studies are uncontrolled or have very short ischemia times. The hypothesis was that due to the extra donor warm ischemia time in DCD these donorlivers would have microthrombi that caused ischemia to the bile ducts. In the meantime other studies showed that in DCD LT there are no microthrombi. We have studied a cohort of DCD LT with liverperfusion with urokinase before LT and compared with a historic cohort without urokinase perfusion. The use of urokinase was safe (e.g. no more bleeding), but did not improve outcome. The incidence of NAS/ITBL in both groups was similar.

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Why is it important?

Urokinase perfusion of the DCD donorliver before liver transplantation is safe but does not improve outcome. Especially there is no decrease in the incidence of nonanastomotic biliary strictures with urokinase liver perfusion.

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