Rachel Todd, Leonie van Leeuwen, Andrew Rosowicz, Aritz Irizar, Antonios Arvelakis, Joseph DiNorcia, Marcelo Facciuto, Jang Moon, Chiara Rocha, Parissa Tabrizian, Leona Kim-Schluger, Sander S. Florman, M. Zeeshan Akhtar
{"title":"非原位恒温机器灌注阿替普酶治疗循环死亡肝移植捐献","authors":"Rachel Todd, Leonie van Leeuwen, Andrew Rosowicz, Aritz Irizar, Antonios Arvelakis, Joseph DiNorcia, Marcelo Facciuto, Jang Moon, Chiara Rocha, Parissa Tabrizian, Leona Kim-Schluger, Sander S. Florman, M. Zeeshan Akhtar","doi":"10.1111/ctr.70282","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Normothermic machine perfusion (NMP) is increasing the safe utilization of donation after circulatory death livers. Historically, tissue plasminogen activator (tPA) has been administered intraoperatively to DCD graft recipients to reduce non-anastomotic biliary complications (NAS). Treating the liver during NMP offers a potentially safer administration, preventing systemic treatment of the recipient. In this retrospective study, we explore our center's experience of giving tPA with FFP during NMP and its effects on clinical chemistries during perfusion, intraoperative transfusions, and post-operative outcomes and clinical chemistries.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>One hundred and twenty-seven livers were perfused using the OrganOx <i>metra</i>, including 56 DCD livers (tPA + NMP-DCD) that received a bolus of 10 mg tPA followed by a 90-min infusion of 40 mg. Sixty-five livers from donation after brain death donors underwent NMP without tPA (NMP-DBD). A historical, propensity-matched cohort of 78 livers from non-NMP DCD donor livers (<i>n</i> = 51) were an additional comparator group (tPA-DCD).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Intraoperative transfusions, 30-day and 3-month patient survival, and 30-day and 3-month graft survival were not statistically different between the tPA-NMP-DCD and NMP-DBD groups, except for cell saver volumes (<i>p</i> = 0.0034). Less platelets and cryoprecipitate transfusions were observed in the tPA-NMP-DCD livers compared to historical tPA-DCD livers (<i>p </i>= 0.0021 and 0.0046, respectively). One incidence of primary non-function occurred in the tPA-DCD group, and the tPA-NMP-DCD arm had one case of ischemic cholangiopathy required re-transplant. There was a higher reoperation rate for hematoma evacuation in the NMP-DBD cohort. Minimum follow-up time was 5 months.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our results continue to lend support to NMP providing a platform for administering tPA to donor livers, curtailing a potential risk to the recipient.</p>\n </section>\n \n <section>\n \n <h3> Summary</h3>\n \n <p>Administration of tissue plasminogen activator (tPA) can be safely administered during normothermic machine perfusion. For centers who traditionally deploy tPA in recipients for DCD donor livers, delivering during NMP is an alternative safer option sparing the reciepient from exposure.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Treating Donation After Circulatory Death Liver Grafts With Alteplase During Ex Situ Normothermic Machine Perfusion\",\"authors\":\"Rachel Todd, Leonie van Leeuwen, Andrew Rosowicz, Aritz Irizar, Antonios Arvelakis, Joseph DiNorcia, Marcelo Facciuto, Jang Moon, Chiara Rocha, Parissa Tabrizian, Leona Kim-Schluger, Sander S. Florman, M. Zeeshan Akhtar\",\"doi\":\"10.1111/ctr.70282\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Normothermic machine perfusion (NMP) is increasing the safe utilization of donation after circulatory death livers. Historically, tissue plasminogen activator (tPA) has been administered intraoperatively to DCD graft recipients to reduce non-anastomotic biliary complications (NAS). Treating the liver during NMP offers a potentially safer administration, preventing systemic treatment of the recipient. In this retrospective study, we explore our center's experience of giving tPA with FFP during NMP and its effects on clinical chemistries during perfusion, intraoperative transfusions, and post-operative outcomes and clinical chemistries.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>One hundred and twenty-seven livers were perfused using the OrganOx <i>metra</i>, including 56 DCD livers (tPA + NMP-DCD) that received a bolus of 10 mg tPA followed by a 90-min infusion of 40 mg. Sixty-five livers from donation after brain death donors underwent NMP without tPA (NMP-DBD). A historical, propensity-matched cohort of 78 livers from non-NMP DCD donor livers (<i>n</i> = 51) were an additional comparator group (tPA-DCD).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Intraoperative transfusions, 30-day and 3-month patient survival, and 30-day and 3-month graft survival were not statistically different between the tPA-NMP-DCD and NMP-DBD groups, except for cell saver volumes (<i>p</i> = 0.0034). Less platelets and cryoprecipitate transfusions were observed in the tPA-NMP-DCD livers compared to historical tPA-DCD livers (<i>p </i>= 0.0021 and 0.0046, respectively). One incidence of primary non-function occurred in the tPA-DCD group, and the tPA-NMP-DCD arm had one case of ischemic cholangiopathy required re-transplant. There was a higher reoperation rate for hematoma evacuation in the NMP-DBD cohort. Minimum follow-up time was 5 months.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our results continue to lend support to NMP providing a platform for administering tPA to donor livers, curtailing a potential risk to the recipient.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Summary</h3>\\n \\n <p>Administration of tissue plasminogen activator (tPA) can be safely administered during normothermic machine perfusion. For centers who traditionally deploy tPA in recipients for DCD donor livers, delivering during NMP is an alternative safer option sparing the reciepient from exposure.</p>\\n </section>\\n </div>\",\"PeriodicalId\":10467,\"journal\":{\"name\":\"Clinical Transplantation\",\"volume\":\"39 8\",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70282\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70282","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Treating Donation After Circulatory Death Liver Grafts With Alteplase During Ex Situ Normothermic Machine Perfusion
Introduction
Normothermic machine perfusion (NMP) is increasing the safe utilization of donation after circulatory death livers. Historically, tissue plasminogen activator (tPA) has been administered intraoperatively to DCD graft recipients to reduce non-anastomotic biliary complications (NAS). Treating the liver during NMP offers a potentially safer administration, preventing systemic treatment of the recipient. In this retrospective study, we explore our center's experience of giving tPA with FFP during NMP and its effects on clinical chemistries during perfusion, intraoperative transfusions, and post-operative outcomes and clinical chemistries.
Methods
One hundred and twenty-seven livers were perfused using the OrganOx metra, including 56 DCD livers (tPA + NMP-DCD) that received a bolus of 10 mg tPA followed by a 90-min infusion of 40 mg. Sixty-five livers from donation after brain death donors underwent NMP without tPA (NMP-DBD). A historical, propensity-matched cohort of 78 livers from non-NMP DCD donor livers (n = 51) were an additional comparator group (tPA-DCD).
Results
Intraoperative transfusions, 30-day and 3-month patient survival, and 30-day and 3-month graft survival were not statistically different between the tPA-NMP-DCD and NMP-DBD groups, except for cell saver volumes (p = 0.0034). Less platelets and cryoprecipitate transfusions were observed in the tPA-NMP-DCD livers compared to historical tPA-DCD livers (p = 0.0021 and 0.0046, respectively). One incidence of primary non-function occurred in the tPA-DCD group, and the tPA-NMP-DCD arm had one case of ischemic cholangiopathy required re-transplant. There was a higher reoperation rate for hematoma evacuation in the NMP-DBD cohort. Minimum follow-up time was 5 months.
Conclusion
Our results continue to lend support to NMP providing a platform for administering tPA to donor livers, curtailing a potential risk to the recipient.
Summary
Administration of tissue plasminogen activator (tPA) can be safely administered during normothermic machine perfusion. For centers who traditionally deploy tPA in recipients for DCD donor livers, delivering during NMP is an alternative safer option sparing the reciepient from exposure.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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