Use of Tissue Plasminogen Activator in Liver Transplantation from Donation After Cardiac Death Donors
| Autor: | Masato Fujiki, Teresa Diago Uso, Bijan Eghtesad, Federico Aucejo, Charles Winans, Koji Hashimoto, Samuel Irefin, Charles Miller, David P. Vogt, Dympna Kelly, Brian M. Parker, John J. Fung, Cristiano Quintini, Ganesh Gunasekaran |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Graft Rejection Male Excessive Bleeding medicine.medical_specialty Tissue and Organ Procurement Adolescent medicine.medical_treatment Population Urology Constriction Pathologic Liver transplantation Tissue plasminogen activator Ischemia Fibrinolysis medicine Humans Immunology and Allergy Pharmacology (medical) Organ donation Thrombus education Aged Transplantation education.field_of_study T-plasminogen activator business.industry Middle Aged medicine.disease Tissue Donors Liver Transplantation Surgery Death Tissue Plasminogen Activator Female Bile Ducts business medicine.drug |
| Zdroj: | American Journal of Transplantation. 10:2665-2672 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/j.1600-6143.2010.03337.x |
| Popis: | Ischemic-type biliary stricture (ITBS) occurs in up to 50% after liver transplantation (LT) from donation after cardiac death (DCD) donors. Thrombus formation in the peribiliary microcirculation is a postulated mechanism. The aim was to describe our experience of tissue plasminogen activator (TPA) administration in DCD-LT. TPA was injected into the donor hepatic artery on the backtable (n = 22). Two recipients developed ITBS including one graft failure. Although excessive postreperfusion bleeding was seen in 14 recipients, the amount of TPA was comparable between those with and without excessive bleeding (6.4 ± 2.8 vs. 6.6 ± 2.8 mg, p = 0.78). However, donor age (41 ± 12 vs. 29 ± 9 years, p = 0.02), donor BMI (26.3 ± 5.5 vs. 21.7 ± 3.6 kg/m(2) , p = 0.03), previous laparotomy (50% vs. 0%, p = 0.02) and lactate after portal reperfusion (6.3 ± 4.6 vs. 2.8 ± 0.9 mmol/L, p = 0.005) were significantly greater in recipients with excessive bleeding. In conclusion, the use of TPA may lower the risk of ITBS-related graft failure in DCD-LT. Excessive bleeding may be related to poor graft quality and previous laparotomy rather than the amount of TPA. Further studies are needed in larger population. |
| Databáze: | OpenAIRE |
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