Activation of the Plasma Contact System and Hemodynamic Changes After Graft Revascularization in Liver Transplantation

Scholz, Tim; Bäckman, Lars; Mathisen, Øystein; Buø, Laila; Karlsrud, T. S.; Johansen, Harald Thidemann; Bergan, A.; Klintmalm, Göran B.; Aasen, Ansgar O.

doi:10.1097/00007890-199507150-00007

Cited by 20 publications

(12 citation statements)

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“…During the anhepatic phase, all livers were washed out with a solution of cold albumin to eliminate potassium and some mediators that could act as vasodilators at revascularization. 18 Temperature was not different at unclamping. A possible mechanism might be related to a dilutional effect in the VVB group, directing the reperfusate flow through the extracorporeal bypass system and minimizing the importance of the reperfusion phenomenon.…”

Section: Discussionmentioning

confidence: 89%

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

et al. 1997

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Conventional liver transplantation requires crossclamping of the hepatic pedicle and inferior vena cava, leading to severe hemodynamic and metabolic disturbances, usually attenuated by the use of venovenous bypass. A more recent surgical technique, piggyback with temporary portocaval shunting, preserves both caval and portal blood flows. The aim of this study was to compare the two methods prospectively. Forty-four patients with chronic liver disease were studied. Local anatomic conditions guided the surgeon to choose the easiest way to remove the native liver. Anesthetic management was standardized. Hemodynamic and metabolic changes were assessed by use of routine tests at specific periods. Graft function was evaluated by measurement of aminotransferases and monoethylglycinexylidide (MEGX) test 12, 24, 48, and 72 hours postoperatively. Conventional liver transplantation with venovenous bypass was performed in 26 patients, and the piggyback with temporary portocaval shunting was performed in 15 patients. ANOVA showed that cardiac output and systemic oxygen delivery were better maintained before revascularization in the piggyback group. Metabolic changes were comparable, and hyperfibrinolytic activity was detected in both groups. Graft function was comparable and satisfactory within the 3 first postoperative days. Piggyback with temporary portocaval shunting provided better intraoperative hemodynamics and tissue oxygenation than liver transplantation with venovenous bypass.

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Section: Discussionmentioning

confidence: 89%

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

et al. 1997

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“…Reduction in cyclic guanosine 3Ј,5Ј-monophosphate activity, which is an indicator of hepatic energy charge, may be related to PRS. 12 Furthermore, candidate vasoactive substances, such as kallikrein, acetylcholine, prostaglandin, endotoxin, and bradykinin, 5,[13][14][15][16][17] need to be analyzed in recipients of older donor livers.…”

Section: Discussionmentioning

confidence: 99%

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Nanashima

Pillay

Verran

et al. 2002

Transplantation Proceedings

104

120

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“…There is evidence of activation of the kallikrein system during OLT. 17 Activation of kallikrein results in the formation of bradykinin, a potent stimulator of tPA release from endothelial cells. 18 In vitro studies have indicated that aprotinin concentrations greater than 200 KIU/mL are required for adequate inhibition of kallikrein.…”

Section: Discussionmentioning

confidence: 99%

Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect

Molenaar

2001

Liver Transplantation

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Aprotinin reduces blood transfusion requirements in orthotopic liver transplantation (OLT). Concern has been voiced about the potential risk for thrombotic complications when aprotinin is used. The aim of this study is to evaluate the effects of aprotinin on the two components of the hemostatic system (coagulation and fibrinolysis) in patients undergoing OLT. As part of a larger, randomized, double-blind, placebo-controlled study, we compared coagulation ( H emostasis is the overall result of a balance between two proteolytic cascades: the coagulation and fibrinolytic systems. In end-stage liver disease, the delicate balance between coagulation and fibrinolysis is often disturbed. 1,2 One problem encountered in orthotopic liver transplantation (OLT) is the occurrence of hyperfibrinolysis, mainly caused by increased levels of tissue-type plasminogen activator (tPA). 3,4 Especially during the anhepatic and postreperfusion periods, tPA plasma levels are significantly increased, resulting in consumption of its naturally occurring inhibitor, plasminogen activator inhibitor (PAI-1). 5,6 High tPA activity during OLT stimulates the conversion of plasminogen into plasmin, which causes premature degradation of fibrin clots and subsequent increased blood loss and transfusion requirements. 6 Aprotinin is a serine protease inhibitor derived from bovine lung. 7 It has the ability to inhibit a wide range of proteases that have serine residues at their active site, such as plasmin, kallikrein, and trypsin, by forming reversible stoichiometric enzyme-inhibitor complexes. Inhibition of plasmin and kallikrein results in a strong reduction in fibrinolysis. Neuhaus et al 8 first reported on the blood-sparing effect of aprotinin in OLT. Recently, we completed the European Multicenter Study on the Use of Aprotinin in Liver Transplantation (EMSALT). Results of this randomized, double-blind, placebo-controlled study showed significant reductions in blood loss and transfusion requirements of 50% and 30%, respectively. 9 A potential adverse effect of a prohemostatic drug, such as aprotinin, could be an increased rate of thrombotic complications. Concern has been voiced about the potential risk for this type of complication when aprotinin is administered during OLT. 10 Although the antifibrinolytic activity of aprotinin in OLT has been studied before, data on the specific effects of aprotinin on coagulation and fibrinolysis separately, as well as their interaction in the same

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Activation of the Plasma Contact System and Hemodynamic Changes After Graft Revascularization in Liver Transplantation

Cited by 20 publications

References 0 publications

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect

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