{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:26:20Z","timestamp":1776471980390,"version":"3.51.2"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:p>The aim of the present study was to assess whether flushing the donor liver with urokinase immediately before implantation reduces the incidence of nonanastomotic biliary strictures (NASs) after liver transplantation, without causing increased blood loss, analyzed as a historical cohort study. Between January 2005 and October 2012, all liver (re\u2010)transplantations were included. Of the 185 liver transplant recipients included, 63 donor livers between January 2010 and October 2012 received urokinase (study group), whereas the donor liver of 122 consecutive recipients, who served as a historical control group, between January 2005 and January 2010 did not receive urokinase. Basic donor (Eurotransplant donor risk index) and recipient (age, body mass index, laboratory Model for End\u2010Stage Liver Disease score) characteristics did not significantly differ in both groups. Thirty\u2010three recipients developed NASs: 22 in the control group (18%) and 11 (17.5%) in the study group (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.68). Analyzed separately for donation after circulatory death (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.42) or donation after brain death (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.89), there was no difference between the groups in incidence of NAS. Of all the recipients developing NAS, 7 (21%) needed retransplantation and all others were treated conservatively. Autologous blood transfusion requirements did not differ significantly between both groups (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.91), whereas interestingly, more heterologous blood transfusions were needed in the control group (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001). This study has its limitations by its retrospective character. A multi\u2010institutional prospective study could clarify this issue. In conclusion, arterial flushing of the liver with urokinase immediately before implantation did not lead to a lower incidence of NAS in this study, nor did it lead to increased blood loss. <jats:italic toggle=\"yes\">Liver Transplantation 22 420\u2010426 2016<\/jats:italic> AASLD<\/jats:p>","DOI":"10.1002\/lt.24370","type":"journal-article","created":{"date-parts":[[2015,11,24]],"date-time":"2015-11-24T16:34:26Z","timestamp":1448382866000},"page":"420-426","source":"Crossref","is-referenced-by-count":13,"title":["Flushing the liver with urokinase before transplantation does not prevent nonanastomotic biliary strictures"],"prefix":"10.1097","volume":"22","author":[{"given":"Lars C.","family":"Pietersen","sequence":"first","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the Netherlands"},{"name":"Eurotransplant International Foundation,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Claire","family":"den Dulk","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andries E.","family":"Braat","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hein","family":"Putter","sequence":"additional","affiliation":[{"name":"Medical Statistics,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerem Sebib","family":"Korkmaz","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre G.","family":"Baranski","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander F. M.","family":"Schaapherder","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen","family":"Dubbeld","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart","family":"van Hoek","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Leiden University Medical Center,Leiden,the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Ringers","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery,Leiden University Medical Center,Leiden,the 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