Response to “Minimization of Ischemic Cholangiopathy in Donation After Cardiac Death Liver Transplantation: Is it Thrombolytic Therapy or Warm Ischemic Time Stringency and Donor Bile Duct Flush?”

We thank Giorgakis and colleagues for their interest in our recent published article (1, 2). Since the etiology of ischemic cholangiopathy (IC) in Donation after Cardiac Death (DCD) for Liver Transplantation (LT) is not well defined, hypotheses include ischemia–reperfusion injury, microvascular thrombosis, cytotoxic injury, and impaired biliary epithelial regeneration (3-5), adopting a multifaceted protocol to optimize perioperative conditions is essential. We concur with their observation that fast organ recovery with rapid decompression, in-situ aortic and portal flushing, biliary tree flushing –and in our institution, retrograde venous flushing-, keep short ischemic times, careful donor–recipient selection and pristine technical implantation are imperative to good outcomes. This article is protected by copyright. All rights reserved.