Coagulation profiles and intraoperative substitution requirements during elective piggyback liver transplantation with prophylactic antifibrinolytic therapy

Weber, Thomas; Sendt, Wolfgang; Grube, Thomas; Scheele, J.

doi:10.1111/j.1432-2277.2002.tb00170.x

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The piggyback technique was used in all the procedures, which was carried out by anesthesiologists and surgeons from the same single unit, using the same transfusion strategy. Intraoperative hemostatic changes and blood loss during liver transplantation are well characterized in the literature, with hyperfibrinolysis occurring late in the anhepatic phase and immediately after reperfusion, due to absent hepatic clearance and increased release (from the ischemic endothelium) of tissue‐type plasminogen activator 27, 28. A low degree of preservation injury and earlier graft function in DLT could explain a lower fibrinolytic activity during the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Domino versus deceased donor liver transplantation: Association with early graft function and perioperative bleeding

et al. 2011

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This study sought to evaluate the potential impact of domino liver transplantation (DLT) on initial graft function and early postoperative outcome in patients with cirrhosis in a Portuguese liver transplantation center. A retrospective comparative analysis was performed between 77 domino recipients (from familial amyloidotic polyneuropathy donors) and 91 deceased donor recipients, all submitted to primary elective whole liver transplantation, using the piggyback technique, in a 42-month period. Outcome parameters included graft dysfunction (defined as either primary nonfunction or initial poor function, according to the Ploeg-Maring criteria) and Clavien II-IV complications in the first postoperative week. Domino and deceased donor recipients had similar preoperative severity indices (Child-Pugh classification and Model for End-Stage Liver Disease score) and immediate postoperative severity scores (APACHE II [Acute Physiology and Chronic Health Evaluation II] and SAPS II [Simplified Acute Physiology Score II]). In DLT, donors were younger, cold ischemia time was shorter, and intraoperative transfusion requirements of packed red blood cells and fresh-frozen plasma were significantly lower. Graft dysfunction incidence was 3.4-fold lower in DLT: 5.2% (only 4 cases of initial poor function) versus 18.0% (1 primary nonfunction and 15 cases of initial poor function), P ¼ 0.010. Postoperative bleeding was the most frequent early Clavien II-IV complication (n ¼ 29, 17.3%), with an incidence 2.2-fold lower in domino recipients. A statistically significant difference was not found in the other analyzed Clavien II-IV complications, intensive care unit stay, mechanical ventilation time, intensive care unit mortality, and 1-year survival rate. In conclusion, in this study the younger donors and shorter ischemic time associated with DLT may provide a protective role in regards to graft dysfunction and perioperative bleeding, which are 2 important determinants of early morbidity after liver transplantation. Liver Transpl 17:270-278, 2011. V C 2011 AASLD.Received May 11, 2010; accepted October 2, 2010.The sequential or domino liver transplantation (DLT), using the morphologically normal liver from a familial amyloidotic polyneuropathy (FAP) patient, was first performed in 1995. 1,2 The DLT created a new category of donors and expanded the donor pool, but also raised new technical and ethical issues. 3,4 A technical difficulty arose because domino donors and recipients must share a relatively short segment of the suprahepatic vena cava. Regarding this technical issue, the conventional technique (retrohepatic vena cava excision and venovenous bypass) has been traditionally used in the FAP patient, nonetheless with potential complications. 3,5 A modified piggyback technique, 6 with reconstruction of the suprahepatic venous outflow of the domino graft, allowed FAP hepatectomy to be performed with inferior vena cava preservation and became the standard domino technique in our center. The DLT has also created an ethical dilemma conce...

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Section: Discussionmentioning

confidence: 99%

Domino versus deceased donor liver transplantation: Association with early graft function and perioperative bleeding

et al. 2011

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“…Several factors contribute to excessive bleeding during OLT, including pre-existing coagulopathy in patients [18][19][20] , the procedure of liver transplantation itself, and the experience of the surgeon. However, hemostatic abnormalities due to hyperfibrinolysis remain a major cause.…”

Section: Discussionmentioning

confidence: 99%

Requirements for transfusion and postoperative outcomes in orthotopic liver transplantation: A meta-analysis on aprotinin

Liu¹,

Chen²,

Wang³

2008

WJG

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INTRODUCTIONOrthotopic liver transplantation (OLT) has become the first choice approach for the treatment of patients with end-stage liver diseases [1] . However, despite great improvements in graft preservation, surgical skills, anesthetic techniques and perioperative management [2,3] , OLT is still associated with severe bleeding and considerable transfusion requirements, which in turn greatly contribute to the peri-operative morbidity and mortality [4] . Severe bleeding in OLT occurs for several reasons, among which hemostatic abnormalities remain a major cause [5,6] . Aprotinin, a serine protease inhibitor, is more and more commonly being used in surgeries, such as cardiac surgeries and liver transplantations, to reduce bleeding and the need for transfusions. A meta-analysis of 12 trials (n = 626) of children undergoing cardiac surgery demonstrated aprotinin reduced the proportion of children receiving b l o o d t r a n s f u s i o n s d u r i n g c a r d i a c s u r g e r y w i t h cardiopulmonary bypass, but had no significant effect on the volume of blood transfused or on the amount of chest tube drainage [7] . Similarly, a meta analysis of 13 trials (n = 506) of patients undergoing major orthopedic surgery demonstrated the pooled blood loss and the amounts of red blood cell (RBC) units (U) transfused intraoperatively and peri-operatively were significantly lower among aprotinin-treated patients than control patients. Moreover, aprotinin was not associated with an increased incidence Abstract AIM: To study the effect of aprotinin used in orthotopic liver transplantation (OLT) on the intraoperative requirement for blood products and on the incidence of laparotomy for bleeding, thrombotic events and mortality.

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Preoperative fibrinogen level and blood transfusions in liver transplantation: A systematic review

Thibeault,

Plourde,

Fellouah

et al. 2023

Transplantation Reviews

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Coagulation profiles and intraoperative substitution requirements during elective piggyback liver transplantation with prophylactic antifibrinolytic therapy

Cited by 3 publications

References 24 publications

Domino versus deceased donor liver transplantation: Association with early graft function and perioperative bleeding

Domino versus deceased donor liver transplantation: Association with early graft function and perioperative bleeding

Requirements for transfusion and postoperative outcomes in orthotopic liver transplantation: A meta-analysis on aprotinin

Preoperative fibrinogen level and blood transfusions in liver transplantation: A systematic review

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