Impact of aprotinin on blood transfusion requirements in liver transplantation

Abstract

A retrospective study was carried out to ascertain the blood bank provision required to support a liver transplant programme and to assess the effect of intraoperative aprotinin on blood product requirements in liver transplant recipients with cirrhosis. Sixty patients with end-stage liver disease underwent 62 consecutive orthotopic liver transplants between October 1988 and January 1991. The total and intraoperative requirements of red cells, platelets and fresh frozen plasma (FFP) were analysed for three groups of liver transplant recipients, those without cirrhosis (n = 15), those with cirrhosis (n = 25) and those with cirrhosis who received intraoperative aprotinin (n = 20). Fifteen without cirrhosis had mean total requirements of 15 units of red cells, 18 units of platelets and 16 units of FFP. Twenty patients with cirrhosis who received intraoperative aprotinin had broadly similar requirements. However, blood product requirements for 25 patients with cirrhosis were significantly greater (46 units of red cells, 41 units of platelets, 43 units of FFP, excluding the seven patients with primary biliary cirrhosis). We conclude that a liver transplant programme can be supported by a teaching hospital blood bank. The use of intraoperative aprotinin significantly reduces blood product requirements.

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

“…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).…”

“…However, until the year 2000, the beneficial effect of aprotinin on blood loss during OLT had only been suggested in adults and in children in small, retrospective, nonrandomized studies (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) (3), 137 patients undergoing OLT received either large doses of aprotinin, regular doses of aprotinin, or placebo. Intraoperative blood loss was 60% less in the large dose group and 44% less in the regular dose group compared with the placebo group.…”

Aprotinin reduces red blood cell transfusion in orthotopic liver transplantation: A prospective, randomized, double-blind study

“…Although several studies have reported decreased blood and/or blood-product use with aprotinin during OLT, the majority of these have been either nonrandomized or retrospective in nature. [6][7][8][9][10][11][12] Placebo-controlled randomized studies published to date have shown either significant decreases in transfusion requirements with aprotinin 13,14 or no beneficial effect. 15,16 Thus, the clinical efficacy of aprotinin during OLT remains to be determined: a recent editorial accompanying the study of Porte et al 14 noted that further clinical studies are required.…”

Aprotinin and Nafamostat Mesilate in Liver Surgery: Effect on Blood Loss

“…The second group consisted of studies investigating the use of aprotinin in liver transplantation. In 13 studies, aprotinin and placebo or control groups were compared in patients undergoing liver transplantation [8,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. In three studies a direct comparison of different dosages of aprotinin was made [28, 29, 39].…”