{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:08:56Z","timestamp":1777496936348,"version":"3.51.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2015,2,23]],"date-time":"2015-02-23T00:00:00Z","timestamp":1424649600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2015,2,23]],"date-time":"2015-02-23T00:00:00Z","timestamp":1424649600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:p>Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a high rate of ischemic\u2010type 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\u2009=\u200930 at TGH, n\u2009=\u200955 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\u2009\u00b1\u20093.4 versus 3.1\u2009\u00b1\u20092.3 U, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.74). Overall, biliary strictures occurred less commonly in the tPA\u2010treated group (16.5% versus 33.3%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.07) with a much lower rate of diffuse intrahepatic strictures (3.5% versus 21.2%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.005). After 1 and 3 years, the tPA group versus the non\u2010tPA group had superior patient survival (97.6% versus 87.0% and 92.7% versus 79.7%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.016) and graft survival (96.4% versus 69.7% and 90.2% versus 63.6%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001). 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. <jats:italic toggle=\"yes\">Liver Transpl 21:321\u2013328, 2015<\/jats:italic>. \u00a9 2015 AASLD.<\/jats:p>","DOI":"10.1002\/lt.24071","type":"journal-article","created":{"date-parts":[[2014,12,26]],"date-time":"2014-12-26T07:42:26Z","timestamp":1419579746000},"page":"321-328","source":"Crossref","is-referenced-by-count":81,"title":["Thrombolytic protocol minimizes ischemic\u2010type biliary complications in liver transplantation from donation after circulatory death donors"],"prefix":"10.1097","volume":"21","author":[{"given":"John B.","family":"Seal","sequence":"first","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Humberto","family":"Bohorquez","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor","family":"Reichman","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Kressel","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Ghanekar","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Cohen","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian D.","family":"McGilvray","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark S.","family":"Cattral","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bruce","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Greig","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Carmody","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Grant","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Selzner","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Program, Department of Surgery,Toronto General Hospital, University of Toronto,Toronto,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Loss","sequence":"additional","affiliation":[{"name":"Multi\u2010Organ Transplant Institute, Ochsner Clinic Foundation,New Orleans,LA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2015,2,23]]},"reference":[{"key":"lt24071-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/01.sla.0000186178.07110.92","article-title":"Donation after cardiac death: the University of Wisconsin experience with liver transplantation","volume":"242","year":"2005","journal-title":"Ann Surg"},{"key":"lt24071-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"e003287","DOI":"10.1136\/bmjopen-2013-003287","article-title":"Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study","volume":"3","year":"2013","journal-title":"BMJ 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