Study of clotting factors in liver homotransplantation

Stremple, John F.; Hussey, Clara V.; Ellison, Edwin H.

doi:10.1016/0002-9610(66)90190-5

Cited by 20 publications

(9 citation statements)

References 28 publications

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“…Therefore, a liver subjected to warm ischemia for 30 min is considered acceptable for transplantation. Hutchinson et al (1968) and Stremple et al (1966) have reported that as in our study, many factors were associated with coagulation changes after transplantation. Immediately after transplantation, reduction of clotting factors in the blood occurred.…”

Section: Discussionsupporting

confidence: 50%

Liver transplantation in dogs after 30 minutes of warm ischemia.

Ohkohchi

Sasaki

Namiki

et al. 1986

Tohoku J. Exp. Med.

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In order to investigate the applicability of liver transplantation after warm Ischemia, a partial auxiliary auto-transplantation of the liver after 30 min of warm Ischemia was carried out in 9 mongrel dogs. Among them, 6 dogs survived longer than 7 days. Liver functions, blood coagulability and histological changes were investigated before and after the transplantation. Serum GOT, LDH, and OPT levels were elevated immediately after transplantation, and returned to normal within a few days. Hemostatic tests also showed significant abnormalities after transplantation. Although PT and thrombotest became normal within a week, PTT and antithrombin III remained slightly abnormal for longer periods. Microscopically, vacuolization and degeneration of hepatocytes were observed after transplantation but they recovered completely within 4 weeks. Based on these results, it could be said that the livers subjected to warm ischemia for 30 min ischemia were still acceptable for auxiliary transplantation.liver transplantation ; liver function test ; hemostatic test Recently, liver transplantation has been carried out in many countries (Starzl et al. 1982;Mac Dougall and Williams 1983: Pichlmayr et al. 1983;Bismuth and Houssin 1984), and its indications have been expanded. In liver transplantation, massive hemorrhaging due to abnormal blood coagulation, in addition to hepatic dysfunction, is very troublesome. Actually more than 50 liter of whole blood, a large amount of platelets and fresh frozen plasma are often required during an operation. When the liver is removed from the donor, warm ischemia and consequent damage of the liver may occur as results of a decreased blood pressure or heart failure during the removal. As a rule, a liver with warm ischemia is thought to be not acceptable for transplantation (Starzl et al. 1964). However, if these livers are transplantable, the number of donors would increase greatly.

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Section: Discussionsupporting

confidence: 50%

Liver transplantation in dogs after 30 minutes of warm ischemia.

Ohkohchi

Sasaki

Namiki

et al. 1986

Tohoku J. Exp. Med.

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“…However, the mean increase in platelet count after platelet infusion during the early part of the third stage of surgery was not different from that in the first stage. Fifth, as postulated by Stremple et al, levels of heparin or a heparinlike substance may be increased (23). However, of 13 patients who received the TT and reptilase time test, TT was prolonged significantly in only two patients, indicating that heparin or a heparin-like substance plays a rather minor role in coagulopathy.…”

Section: Discussionmentioning

confidence: 86%

Intraoperative Changes in Blood Coagulation and Thrombelastographic Monitoring in Liver Transplantation

Kang

Martin

Marquez

et al. 1985

Anesthesia & Analgesia

627

432

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The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors. Keywords BLOOD-coagulation; LIVER-transplantationLiver transplantation, which began as highly experimental surgery 20 yr ago, is now recognized as a major means of therapy for patients with end-stage liver disease (1). However, massive blood loss during liver transplantation is still a major concern. The liver produces most of the blood coagulation factors, so it is not surprising that we see very low levels of these factors and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) in many patients receiving liver transplants (2). Frequently we have seen thrombocytopenia, which may result from gastrointestinal bleeding, splenomegaly, or malnutrition (3). At the same time, numerous collateral channels and portal hypertension, together with increased capillary fragility, make maintenance of surgical hemostasis very difficult.Previous studies on the blood coagulation system in humans and in animals undergoing liver transplantation have demonstrated dilutional coagulopathy associated with massive blood transfusion, decreased fibrinogen levels, and thrombocytopenia (4,5). Fibrinolysis, beginning during the anhepatic stage of surgery and becoming "explosive" on reperfusion of the homograft, has been reported (6). A consumption coagulopathy accompanied by an increased level of fibrin degradation products appeared to play a major role (7). However, these observations were limited to a few patients in the early era of liver transplantation, and comprehensive information is still lacking.Another difficulty in the intraoperative management of liver transplantation has been actively monitoring the coagulation system and determining the appropriate treatment during dynamic blood volume changes. The use of the thrombelastograph (TEG) was suggested by von Kaulla et al. (4) and Howland et al. (8). However, the efficacy of thrombelastographic monitoring of blood coagulation during liver transplantatio...

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Section: Dr Daloze Is a Fellow Of The Mclaughlin Foundation Torontomentioning

confidence: 99%

“…1,2 A hemorrhagic diathesis, explained at least partially by increased circulating fibrinolysins, 3 frequently complicated the operative procedure. Derangements in other clotting factors are also known to occur, 3,4 but the presence of thrombocytopenia during the early postoperative period has not been well documented.In the present study, platelet changes in the clinical cases are reviewed. In addition, the magnitude, timing, and duration of thrombocytopenia have been evaluated under controlled circumstances in untreated dogs subjected to orthotopic transplantation, as well as in comparable experiments in which various immunosuppressive agents were provided including antilymphocyte globulin, azathioprine, and prednisone.…”

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confidence: 99%

Platelet Changes Following Clinical And Experimental Hepatic Homotransplantation

Hutchison¹,

Genton²,

Porter³

et al. 1968

Arch Surg

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DURING the last four years, ten patients with liver disease have been treated at the University of Colorado with either orthotopic or auxiliary hepatic homotransplantation.1~2 A hemorrhagic diathesis, explained at least partially by increased circulating fibrinolysins;? frequently complicated the operative procedure. Derangements in other clotting factors are also known to occur,:3.4 but the presence of thrombocytopenia during the early postoperative period has not been well documented.In the present study, platelet changes in the clinical cases are reviewed. In addition, the magnitude, timing, and duration of thrombocytopenia have been evaluated under controlled circumstances in untreated dogs subjected to orthotopic transplantation, as well as in comparable experiments in which various immunosuppressive agents were provided including antilymphocyte globulin, azathioprine, and prednisone. MethodsClinical Studies.-Three altc.mpts a t auxiliary transplantation were performed: One pa-

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Study of clotting factors in liver homotransplantation

Cited by 20 publications

References 28 publications

Liver transplantation in dogs after 30 minutes of warm ischemia.

Liver transplantation in dogs after 30 minutes of warm ischemia.

Intraoperative Changes in Blood Coagulation and Thrombelastographic Monitoring in Liver Transplantation

Platelet Changes Following Clinical And Experimental Hepatic Homotransplantation

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