title: Flushing the liver with urokinase before transplantation does not prevent nonanastomotic biliary strictures.
abstract: 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-)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-Stage Liver Disease score) characteristics did not significantly differ in both groups. Thirty-three recipients developed NASs: 22 in the control group (18%) and 11 (17.5%) in the study group (P = 0.68). Analyzed separately for donation after circulatory death (P = 0.42) or donation after brain death (P = 0.89), 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 (P = 0.91), whereas interestingly, more heterologous blood transfusions were needed in the control group (P < 0.001). This study has its limitations by its retrospective character. A multi-institutional 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.
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.|Eurotransplant International Foundation, Leiden, the Netherlands.
authors.forename: Lars C
authors.initials: LC
authors.lastname: Pietersen
authors.affiliation: Departments of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: A Claire
authors.initials: AC
authors.lastname: den Dulk
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Andries E
authors.initials: AE
authors.lastname: Braat
authors.affiliation: Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: Departments of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Kerem Sebib
authors.initials: KS
authors.lastname: Korkmaz
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Andre G
authors.initials: AG
authors.lastname: Baranski
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Alexander F M
authors.initials: AF
authors.lastname: Schaapherder
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dubbeld
authors.affiliation: Departments of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.affiliation: Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014019:Tissue Donors; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014568:Urokinase-Type Plasminogen Activator