Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors

Abstract

With interest, we have read the article by Seal et al. recently published in Liver Transplantation. The authors proposed that injection of tissue plasminogen activator, a potent thrombolytic agent, into the hepatic artery of donation after circulatory death (DCD) donor livers before transplantation reduces the incidence of biliary strictures after liver transplantation. We would like to challenge the basis for this potentially harmful therapy and wonder whether there is any evidence for the presence of thrombi in the biliary microcirculation of livers from DCD donors.