Coagulation and Fibrinolysis in Orthotopic Liver Transplantation: Role of the Recipient’s Disease and Use of Antithrombin III Concentrates

Abstract

In this study we report the data obtained from extensive haemostatic testing of 25 patients undergoing orthotopic liver transplantation and the results of an open randomized pilot trial of antithrombin III concentrate administration during surgery. Marked differences in transfusional needs and in pre- and intraoperative blood coagulation and fibrinolytic changes were observed between recipients with liver cirrhosis and those with primary biliary cirrhosis. In the former, the increases in tissue-type plasminogen activator activity, total euglobulin fibrinolytic activity, and fibrin-derived degradation products occurred earlier and were more marked, as were the signs of increased thrombin formation. Supplementation of antithrombin III concentrate during surgery failed to induce significant changes in the main parameters studied and in the transfusional needs.

Altered calcium signalling in platelets from bile-duct-ligated rats

“…Several studies indicate that cholestatic diseases are associated with alterations in platelet function [1][2][3][4][5]. These results point to alterations that may be related to abnormalities in Ca 2+ homoeostasis.…”

“…These disorders are associated with a better outcome of variceal bleeding and less blood loss at transplantation [1][2][3]. Although the origin of this alteration is not clear, a previous study [4] has suggested the existence of a hypercoagulable state in patients with primary biliary cirrhosis, due to a more effective platelet function in these patients than in those suffering from other liver disorders.…”

The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease

“…In human studies AT III activity was commonly increased to more than 80 %. However, there were no significant beneficial effects concerning attenuation of DIC as reflected by laboratory markers, prevention of bleeding or clinical complications when AT III was given perioperatively in patients undergoing the Le Veen shunt operation, hepatic resection, or liver transplantation [9][10][11][12][13].…”

“…Since AT III substitution decreases fibrinogen turnover [7,8], decreased AT III activity possibly contributes in an important way to the increased fibrinogen turnover in patients with liver cirrhosis [8]. Therefore, AT III substitution may prevent the perioperative progression of low-grade to overt DIC [9][10][11][12][13]. AT III-substitution has also been recommended prior to procoagulant coagulation factor substitution Table 1 Biometrical data, Child classification [11], and diagnoses of 24 patients with chronic end-stage liver cirrhosis (median and range) [9][10][11][12][13].…”

“…Therefore, AT III substitution may prevent the perioperative progression of low-grade to overt DIC [9][10][11][12][13]. AT III-substitution has also been recommended prior to procoagulant coagulation factor substitution Table 1 Biometrical data, Child classification [11], and diagnoses of 24 patients with chronic end-stage liver cirrhosis (median and range) [9][10][11][12][13]. We, therefore, tested the hypothesis that an increase in AT III-activity to supranormal (175 %) activity decreases systemic procoagulant turnover in patients with endstage liver disease better than substitution to 100 % activity.…”