Bootcongres

Introduction Ischemic injury of the peribiliary vascular plexus plays a critical role in the occurrence of ischemic-type biliary lesions (ITBL) after liver transplantation. Flushing the graft with a thrombolytic agent may solve this problem. This may cause more bleeding due to its effect on the clotting system. 
The aim of the present study was to assess whether flushing the donor liver with urokinase, prior to transplantation, has a positive effect on reducing the number of ITBL, without a higher risk of bleeding. 

Patients and Methods Between January 2005 and October 2012, with a follow-up through October 2013, all patients receiving a liver transplantation were included. Exclusion criteria were patients who received a domino liver, a split liver or auxiliary liver transplant, or unknown data. Clinical information was obtained from a prospectively collected database.  

Results A total of 205 patients were operated in the given period of which 21 were excluded. Of the 184 patients included, 122 did not receive urokinase (control group) and 62 patients received urokinase (study group). Basic donor characteristics (ET-DRI) and recipient characteristics (age, BMI, lab MELD) did not significantly differ in both groups. Thirty-five patients developed ITBL. In the control group 23 (18%) and 12 patients in the study group (17%), resulting in a not-significant difference (p = 0.94). Comparing only DCD-donors from both groups also does not show a significant decrease in ITBL (P=0.53). 
Autologous blood transfusion did not differ significantly between both groups (p=0.82).  Heterologous blood transfusion differed significantly between both groups (p<0.01), with surprisingly more need for packed cells in the control group.  Discussion  Contrary to previous studies, this (small) pilot study could not find a decrease in the prevalence of ITBL in patients treated with urokinase before implantation. The moment of intervention, before implantation versus during organ procurement, could be an explanation. A larger prospective study with administration of a thrombolytic agent during organ procurement of may clarify this issue. Further, flushing with urokinase before implantation does not lead to more bleeding and is therefore safe for the patient.