Coagulability and fibrinolytic changes during veno-venous bypass in liver transplantation.

Abstract

In clinical liver transplantation, a venous bypass that rechannels the blood flow from the inferior vena cava and portal vein to the superior vena cava has been used to maintain the venous return. However, the usage of mechanical shunt has given rise to derangements of blood coagulability and fibrinolysis. Therefore, changes of coagulability and fibrinolysis during the venous bypass were examined in dogs using a centrifugal pump (Bio-Pump®), and the effect of gabexate mesilate for coagulation were studied. Venous bypass from the inferior vena cava and the portal vein to the external jugular vein was performed in mongrel dogs (group A : bypass without pump, group B : bypass with the Bio-Pump, group C : bypass with the Bio-Pump and the addition of gabexate mesilate). In group A, blood pressure gradually decreased, but in groups B and C it maintained the pre-bypass level. All results of coagulation parameters and fibrinolytic measurements of group B were not significantly different from those of group A ; only partial thromboplastin time was prolonged in group B. However, this prolongation was effectively prevented by the addition of gabexate mesilate in group C.veno-venous bypass ; liver transplantation ; gabexate mesilate ; fibrinolysis ; coagulation testIn clinical liver transplantation, obstruction of the inferior vena cava and the portal vein causes hypotension and a decrease in cardiac output when hepatectomy or an implantation of a new liver is carried out (Pappas et al. 1971). Recently, a pump-driven veno-venous bypass that transmits blood from the inferior vena cava and the portal vein into the superior vena cava is employed to maintain the cardiac output and arterial pressure during anhepatic phase (Shaw et al. 1984). The systemic heparinization using veno-venous bypass is discouraged because of major difficulties in reversing the heparin effect in patients with

Risks of donation and quality of donors' life after living donor liver transplantation

“…None of the donors showed abnormal data in blood tests on preoperative assessment. We transected the donor liver without using the vascular occlusion technique [11].…”

“…In our institute we have performed 68 LDLTx from July 1991 to July 2003. We transect the donor liver without using the vascular occlusion technique [11]. We retrospectively reviewed the safety of our donor operations based on parameters such as blood loss, blood transfusion, operation time, duration of hospitalization and complications.…”

The safety of the donor operation in living-donor liver transplantation: an analysis of 45 donors

“…Therefore, we should pay close attention to the donor's general condition during and after graftectomy, in addition to preserving the viability of the graft. We continuously injected gabexate mesilate to suppress blood coagulation [4]. After division of the liver parenchyma, we waited for 1 h to allow the graft to recover from the surgical manipulation, however, we have no data on this.…”

“…Therefore, the safety of the donor operation must be guaranteed while the viability of the graft is maintained. In our institute we transect the donor liver without using the vascular occlusion technique [4] and inject gabexate mesilate into the portal vein after cannulation to maintain the viability of the graft [2]. We retrospectively reviewed the safety of our donor operations based on parameters such as blood loss, blood transfusion, operation time, duration of hospitalization, and complications.…”

Regional anticoagulation magnetic artificial blood vessels constructed by heparin-PLCL core–shell nanofibers for rapid deployment of veno-venous bypass

“…For example, these strategies usually require systemic anticoagulation, which is dangerous for patients with liver disease. 15,16 Moreover, the current VVB strategies are tedious and time-consuming. 7,12 Electrospinning is a simple and straightforward fabrication process, which, on one hand, is developing and differentiating into coaxial, [17][18][19][20] side-by-side, 21,22 tri-axial 23 and some other complicated processes.…”