Endogenous Heparin-Like Substances Significantly Impair Coagulation in Patients Undergoing Orthotopic Liver Transplantation

Kettner, Stephan C.; Gonano, C.; Seebach, Frank; Sitzwohl, Christian; Acimovic, S.; Stark, Josef; Schellongowski, Axel; Blaicher, Alex M.; Felfernig, Michael; Zimpfer, Michael

doi:10.1097/00000539-199804000-00002

Cited by 50 publications

(50 citation statements)

References 13 publications

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“…This effect has been explained by the release of heparin from the donor liver after heparinization of the donor [24], or by release of endogenous heparin-like substances from the damaged ischemic graft endothelium [31]. This effect is generally short-lasting.…”

Section: Hemostatic Disorders In Liver Transplantationmentioning

confidence: 99%

Minimizing Blood Loss in Liver Transplantation: Progress through Research and Evolution of Techniques

Boer

Molenaar²,

Hendriks³

et al. 2005

Dig Surg

148

123

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Blood loss during liver transplantation has long been recognized as an important cause of morbidity and, especially in the early days, also mortality. It is well known that blood transfusions are associated with an increased risk of postoperative complications, such as infections, pulmonary complications, protracted recovery, and a higher rate of reoperations. Many studies have been performed during the past decades to elucidate the mechanisms of increased blood loss in liver transplantation. In the late 1980s, primary hyperfibrinolysis was identified as an important mechanism of bleeding during liver transplantation. This has provided the scientific basis for the use of antifibrinolytic drugs in liver transplant recipients. Several randomized, controlled studies have shown the efficacy of these compounds in reducing blood loss and transfusion requirements during liver transplantation. In addition, increasing experience and improvements in surgical technique, anesthesiological care and better graft preservation methods have contributed to a steady decrease in blood transfusion requirements in most liver transplant programs. Several centers are now reporting liver transplantation without any need for blood transfusion in up to 30% of their patients. Despite these improvements, most patients undergoing liver transplantation still require blood transfusions that have a negative impact on outcome, emphasizing the need for further attempts to control blood loss by surgeons and anesthesiologists. This paper provides an overview of the clinical and research developments, which have contributed to a reduction in blood loss and transfusion requirements, resulting in an important reduction in morbidity and mortality after liver transplantation during the last two decades.

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Section: Hemostatic Disorders In Liver Transplantationmentioning

confidence: 99%

Minimizing Blood Loss in Liver Transplantation: Progress through Research and Evolution of Techniques

Boer

Molenaar²,

Hendriks³

et al. 2005

Dig Surg

148

123

View full text Add to dashboard Cite

show abstract

“…La réalisation d'un test modifié par ajout d'héparinase permet de distinguer les perturbations des paramètres dues à l'héparine des autres causes [14].…”

Section: Transplantation Hépatiqueunclassified

Thromboélastométrie rotative : réhabilitation de l'ancienne thromboélastographie

Rugeri

Delecroix

Scherrer

et al. 2006

Immuno-analyse & Biologie Spécialisée

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“…During the anhepatic stage, coagulation factors are further depleted, and clearance of activated factors and inhibitors is impaired. With reperfusion, coagulation is further exaggerated as a result of tissue plasminogen activator and heparin released from the donor liver, hypothermia, and additional dilutional effects [2][3][4].To assess these abrupt changes of hemostatic status, the value of continual coagulation monitoring is widely accepted. Routine laboratory screening tests provide essential information, but results often are supplied too late to accurately reflect a changing situation.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…The problem of diagnostic delay may be overcome by the development of rapid bedside techniques for determining prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count. Thromboelastography (TEG) [2][3][4] and use of the Sonoclot (Sienco, Wheat Ridge, CO, USA) [5,6], sensitive bedside techniques quantifying the rate and quality of fibrin formation by measuring viscoelastic properties, provide excellent qualitative data. Although the maintenance of blood coagulability using TEG has been shown to reduce blood and fluid infusion volume [2], other monitors have not yet been fully evaluated.…”

mentioning

confidence: 99%

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Coagulation monitoring and management during liver transplantation

Murakawa

2003

Journal of Anesthesia

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In this issue, Adachi [1] describes the anesthetic management of the liver transplant recipient from a livingrelated donor. Transplantation is indicated when the liver disease progresses to major functional impairment. Advanced hepatic failure produces complex physiological and biochemical effects; the surgical procedure is lengthy and often causes many problems. The management of such patient thus presents a redoubtable challenge for the anesthesiologist.One of the most knotty problems that occurs during liver transplantation is hemostatic disturbance. Coagulopathy is often present before transplant and is characterized by decreases in coagulation factors, qualitative and quantitative platelet defects, and fibrinolysis. Massive surgical bleeding commonly leads to dilutional coagulopathy in addition to pre-existing problems. During the anhepatic stage, coagulation factors are further depleted, and clearance of activated factors and inhibitors is impaired. With reperfusion, coagulation is further exaggerated as a result of tissue plasminogen activator and heparin released from the donor liver, hypothermia, and additional dilutional effects [2][3][4].To assess these abrupt changes of hemostatic status, the value of continual coagulation monitoring is widely accepted. Routine laboratory screening tests provide essential information, but results often are supplied too late to accurately reflect a changing situation. The problem of diagnostic delay may be overcome by the development of rapid bedside techniques for determining prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count. Thromboelastography (TEG) [2-4] and use of the Sonoclot (Sienco, Wheat Ridge, CO, USA) [5,6], sensitive bedside techniques quantifying the rate and quality of fibrin formation by measuring viscoelastic properties, provide excellent qualitative data. Although the maintenance of blood coagulability using TEG has been shown to reduce blood and fluid infusion volume [2], other monitors have not yet been fully evaluated.To maintain sufficient hemostasis during the dissection and anhepatic phases, transfusion of fresh frozen plasma (FFP) is generally required to replace clotting factors that are lost during the surgical procedure. However, during the neohepatic stage, over-transfusion should be avoided because the use of FFP may lead to hepatic artery thrombosis (HAT) [7,8]. HAT is the second leading cause of graft failure in the immediate postoperative period, and the rates of HAT are increased in the pediatric population. When HAT is detected by ultrasonography or is highly suspected by clinical features, emergent revascularization or retransplantation is required for survival. Mortality rates for patients whose transplantation is complicated by HAT range from 20% to 60%. The literature suggests that urgent revascularization may salvage 20%-40% of grafts, but the majority of patients will require retransplantation [9]. Therefore, the prophylaxis of HAT is essential for the recipient's survival in Japan, where bra...

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Endogenous Heparin-Like Substances Significantly Impair Coagulation in Patients Undergoing Orthotopic Liver Transplantation

Cited by 50 publications

References 13 publications

Minimizing Blood Loss in Liver Transplantation: Progress through Research and Evolution of Techniques

Minimizing Blood Loss in Liver Transplantation: Progress through Research and Evolution of Techniques

Thromboélastométrie rotative : réhabilitation de l'ancienne thromboélastographie

Coagulation monitoring and management during liver transplantation

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