{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:23:48Z","timestamp":1783085028602,"version":"3.54.6"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"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":[[2018,5]]},"abstract":"<jats:p>Ischemic\u2010type biliary lesions (ITBLs) arise most frequently after donation after circulatory death (DCD) liver transplantation and result in high morbidity and graft loss. Many DCD grafts are discarded out of fear for this complication. In theory, microvascular thrombi deposited during donor warm ischemia might be implicated in ITBL pathogenesis. Herein, we aim to evaluate the effects of the administration of either heparin or the fibrinolytic drug tissue plasminogen activator (TPA) as means to improve DCD liver graft quality and potentially avoid ITBL. Donor pigs were subjected to 1 hour of cardiac arrest (CA) and divided among 3 groups: no pre\u2010arrest heparinization nor TPA during postmortem regional perfusion; no pre\u2010arrest heparinization but TPA given during regional perfusion; and pre\u2010arrest heparinization but no TPA during regional perfusion. In liver tissue sampled 1 hour after CA, fibrin deposition was not detected, even when heparin was not given prior to arrest. Although it was not useful to prevent microvascular clot formation, pre\u2010arrest heparin did offer cytoprotective effects during CA and beyond, reflected in improved flows during regional perfusion and better biochemical, functional, and histological parameters during posttransplantation follow\u2010up. In conclusion, this study demonstrates the lack of impact of TPA use in porcine DCD liver transplantation and adds to the controversy over whether the use of TPA in human DCD liver transplantation really offers any protective effect. On the other hand, when it is administered prior to CA, heparin does offer anti\u2010inflammatory and other cytoprotective effects that help improve DCD liver graft quality. <jats:italic toggle=\"yes\">Liver Transplantation 24 665\u2013676 2018<\/jats:italic> AASLD.<\/jats:p>","DOI":"10.1002\/lt.25013","type":"journal-article","created":{"date-parts":[[2018,1,19]],"date-time":"2018-01-19T17:22:40Z","timestamp":1516382560000},"page":"665-676","source":"Crossref","is-referenced-by-count":18,"title":["Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model"],"prefix":"10.1097","volume":"24","author":[{"given":"Amelia J.","family":"Hessheimer","sequence":"first","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Vendrell","sequence":"additional","affiliation":[{"name":"Departments of Anesthesia,Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel","family":"Ru\u00edz","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Liver Transplant Surgery, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Pathology,Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Flores","family":"Sig\u00fcenza","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Rodr\u00edguez","family":"Lanzilotta","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Delgado Oliver","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Fuster","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miquel","family":"Navasa","sequence":"additional","affiliation":[{"name":"Liver Unit, Institut de Malalties Digestives i Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer,Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Garc\u00eda\u2010Valdecasas","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Taur\u00e1","sequence":"additional","affiliation":[{"name":"Departments of Anesthesia,Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantino","family":"Fondevila","sequence":"additional","affiliation":[{"name":"Department of Surgery,Institut de Malalties Digestives I Metab\u00f2liques, Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"},{"name":"Department of Hepatobiliary and Liver Transplant Surgery, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4,10]]},"reference":[{"key":"lt25013-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00534-005-1080-2","article-title":"Causes and consequences of ischemic\u2010type biliary lesions after liver transplantation","volume":"13","year":"2006","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"lt25013-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SLA.0b013e318204e658","article-title":"Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta\u2010analysis","volume":"253","year":"2011","journal-title":"Ann Surg"},{"key":"lt25013-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/SLA.0b013e3182104784","article-title":"Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long\u2010term outcomes from a single center","volume":"253","year":"2011","journal-title":"Ann Surg"},{"key":"lt25013-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"3414","DOI":"10.1111\/j.1600-6143.2012.04242.x","article-title":"Prediction models of donor arrest and graft utilization in liver transplantation from maastricht\u20103 donors after circulatory death","volume":"12","year":"2012","journal-title":"Am J Transplant"},{"key":"lt25013-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.1600-6143.2011.03834.x","article-title":"Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation","volume":"12","year":"2012","journal-title":"Am J Transplant"},{"key":"lt25013-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1002\/lt.24460","article-title":"Can we prevent ischemic\u2010type biliary lesions in donation after circulatory 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donor liver transplantation","volume":"100","year":"2016","journal-title":"Transplantation"},{"key":"lt25013-bib-0010-20240115","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1111\/ajt.14261","article-title":"Safety and outcomes in 100 consecutive donation after circulatory death liver transplants using a protocol that includes thrombolytic therapy","volume":"17","year":"2017","journal-title":"Am J Transplant"},{"key":"lt25013-bib-0011-20240115","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/MOT.0000000000000315","article-title":"Abdominal regional in\u2010situ perfusion in donation after circulatory determination of death donors","volume":"21","year":"2016","journal-title":"Curr Opin Organ Transplant"},{"key":"lt25013-bib-0012-20240115","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/tri.12344","article-title":"Hypothermic or normothermic abdominal regional perfusion in high\u2010risk donors with extended warm ischemia times: impact on 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