Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death.

Kumar Jayant,A Shapiro,Isabella Reccia,Francesco Virdis

doi:10.3390/jcm7110425

Abstract

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

Highlights

Liver transplantation has been established as a life-saving therapy and mainstay treatment for all forms of end-stage liver disease
The present study aims to systematically review the literature and where possible statistically compare the available data to compare outcomes for rates of ischemic-type biliary lesions (ITBLs), biliary complications, hepatic artery thrombosis (HAT), graft and patient survival, and blood transfusion following administration of thrombolytic flush in donor after cardiac death (DCD) liver transplantation
The detailed data of all the studies related to the adverse events, ITBLs, biliary complications, hepatic artery thrombosis, the requirement of blood transfusion, and patient and graft survival are summarized in Tables 2 and 3

Summary

Introduction

Liver transplantation has been established as a life-saving therapy and mainstay treatment for all forms of end-stage liver disease. To counter the paucity of organs, transplant centers have broadened the graft acceptance criteria to incorporate high risk, extended criteria donors (ECDs), including organs from donor after cardiac death (DCD) donors, despite the fact that such livers have an increased risk for complications. The use of DCD liver donors has risen steadily and accounts for 5–10% of all liver transplants performed in North America [4]. In spite of these promising trends, the overzealous use of DCD donors has been trounced by the high risks of dispiriting outcomes like biliary complications, hepatic artery thrombosis, and primary nonfunction (PNF) [5,6,7]. Analysis of the data from the Scientific Registry of Transplant Recipients (SRTR) reported inferior post-transplantation outcomes with the DCD group over donation after brain death (DBD) due to poor graft quality [6]

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