Seal John B, Bohorquez Humberto, Reichman Trevor, Kressel Adam, Ghanekar Anand, Cohen Ari, McGilvray Ian D, Cattral Mark S, Bruce David, Greig Paul, Carmody Ian, Grant David, Selzner Markus, Loss George
Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Liver Transpl. 2015 Mar;21(3):321-8. doi: 10.1002/lt.24071.
Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a high rate of ischemic-type biliary strictures (ITBSs) and inferior graft survival. To investigate the impact of an intraoperative tissue plasminogen activator (tPA) on outcomes following DCD LT, we conducted a retrospective analysis of DCD LT at the Toronto General Hospital (TGH) and the Ochsner Medical Center (OMC). Between 2009 and 2013, 85 DCD LTs were performed with an intraoperative tPA injection (n = 30 at TGH, n = 55 at OMC), and they were compared with 33 DCD LTs without a tPA. Donor and recipient characteristics were similar in the 2 groups. There was no significant difference in the intraoperative packed red blood cell transfusion requirement (3.2 ± 3.4 versus 3.1 ± 2.3 U, P = 0.74). Overall, biliary strictures occurred less commonly in the tPA-treated group (16.5% versus 33.3%, P = 0.07) with a much lower rate of diffuse intrahepatic strictures (3.5% versus 21.2%, P = 0.005). After 1 and 3 years, the tPA group versus the non-tPA group had superior patient survival (97.6% versus 87.0% and 92.7% versus 79.7%, P = 0.016) and graft survival (96.4% versus 69.7% and 90.2% versus 63.6%, P < 0.001). In conclusion, a tPA injection into the hepatic artery during DCD LT reduces ITBSs and improves graft and patient survival without increasing the risk for bleeding.
采用循环死亡后器官捐献（DCD）供体进行的肝移植（LT）与缺血性胆管狭窄（ITBS）的高发生率及移植物生存率较低相关。为了研究术中组织纤溶酶原激活剂（tPA）对DCD肝移植术后结局的影响，我们对多伦多综合医院（TGH）和奥施纳医疗中心（OMC）的DCD肝移植进行了一项回顾性分析。2009年至2013年期间，85例DCD肝移植术中进行了tPA注射（TGH为30例，OMC为55例），并与33例未使用tPA的DCD肝移植进行比较。两组供体和受体特征相似。术中红细胞悬液输注需求量无显著差异（3.2±3.4单位对3.1±2.3单位，P = 0.74）。总体而言，tPA治疗组胆管狭窄的发生率较低（16.5%对33.3%，P = 0.07），弥漫性肝内狭窄的发生率低得多（3.5%对21.2%，P = 0.005）。1年和3年后，tPA组与非tPA组相比，患者生存率更高（97.6%对87.0%以及92.7%对79.7%，P = 0.016），移植物生存率也更高（96.4%对69.7%以及90.2%对63.6%，P < 0.001）。总之，DCD肝移植术中向肝动脉注射tPA可减少ITBS，提高移植物和患者生存率，且不增加出血风险。
