Aprotinin efficacy on intraoperative bleeding and transfusion requirements in orthotopic liver transplantation

Patrassi, G; Viero, M.; Sartori, M. T.; Silvestro, Giustina De; Rossaro, Lorenzo; Burra, Patrizia; Nolli, Maria Luisa; Piccinni, Pasquale; Bassi, Nicolò

doi:10.1046/j.1537-2995.1994.34694295066.x

Cited by 52 publications

(26 citation statements)

References 23 publications

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“…These investigators observed a reduction of blood loss and transfusion requirements of 35 and 50%, respectively, in 10 patients undergoing liver transplantation, compared to historical controls. Several studies on the use of aprotinin in liver transplantation have been performed since then [45,46,47,48]. However, in most of these studies retrospective control groups were used or the studies were too small to draw definite conclusions.…”

Section: Pharmacological Strategies To Reduce Blood Lossmentioning

confidence: 99%

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

Boer

Molenaar²,

Hendriks³

et al. 2005

Dig Surg

149

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: Pharmacological Strategies To Reduce Blood Lossmentioning

confidence: 99%

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

Boer

Molenaar²,

Hendriks³

et al. 2005

Dig Surg

149

123

View full text Add to dashboard Cite

show abstract

“…The lack of t-PA hepatic clearance during the anhepatic period and t-PA release by the endothelial cells of the revascularized graft account for the increase in t-PA (26). In the 1990's, these findings contributed to the widespread intraoperative administration of antifibrinolytic drugs, mainly aprotinin in Europe, to prevent or treat the activation of fibrinolysis in an attempt to decrease blood loss and the use of blood products during OLT (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). A large-dose regimen similar to that used in cardiac surgery was proposed (27).…”

Section: Effect Of Aprotinin On Blood Loss and Rbc Transfusion Requirmentioning

confidence: 99%

A Review of Aprotinin in Orthotopic Liver Transplantation: Can Its Harmful Effects Offset Its Beneficial Effects?

Lentschener

Roche²,

Ozier³

2005

Anesthesia & Analgesia

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Blood transfusion can adversely affect patient outcome and graft survival in orthotopic liver transplantation (OLT). With this respect, prophylactic aprotinin administration decreases blood loss, transfusion requirements, and the hemodynamic changes associated with graft reperfusion in patients undergoing OLT. However, data indicate limiting the use of aprotinin in OLT: (a) clinical, biological, echocardiographic, and postmortem findings recorded in patients with chronic liver disease or undergoing OLT suggest that a continuous prothrombotic state exists in these patients. Whether the inhibition of fibrinolysis associated with aprotinin therapy will expose some patients to untoward thrombosis is questionable; (b) aprotinin does not appear to alter postoperative outcome in patients undergoing OLT; (c) aprotinin decreases blood transfusion requirements only when surgery is associated with significant blood loss. However, at the present time, median transfusion requirements of 2 to 5 red blood cell units are required in OLT.

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“…It is a non-specific serin protease inhibitor from bovine lung tissue, inhibits plasmin, trypsin, chymotrypsin, tissue plasminogen activator, kallikrein and thrombin, and decreases multiple markers of inflammation and complement activation following cardiopulmonary bypass (CPB). Aprotinin has antifibrinolytic and platelet preserving activity [1], and reduces blood loss in various cardiac operations, including coronary artery bypass grafting [2], cardiac reoperations [3], CABG on aspirin-treated cases [4] and in orthopaedic operations [5] or organ transplantation [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of recombinant aprotinin on postoperative blood loss and coronary vascular function in a canine model of cardiopulmonary bypass

Veres

Radovits

Schultz

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Aprotinin efficacy on intraoperative bleeding and transfusion requirements in orthotopic liver transplantation

Abstract: Infusion of aprotinin during OLT in cirrhotic patients can be recommended for the prevention of hyperfibrinolysis-triggered bleeding, thus reducing transfusion requirements. A possible protective effect on the primary nonfunction of the grafted liver is suggested.

Cited by 52 publications

References 23 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

A Review of Aprotinin in Orthotopic Liver Transplantation: Can Its Harmful Effects Offset Its Beneficial Effects?

Effect of recombinant aprotinin on postoperative blood loss and coronary vascular function in a canine model of cardiopulmonary bypass

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