Improved early graft survival in patients receiving aprotinin during orthotopic liver transplantation

Molenaar, I. Quintus; Veldman, M.G.; Begliomini, B.; Groenland, HN; Januszkiewicz, Anna; Lindgren, L.; Hj, Metselaar; Ot, Terpstra; Porte, Robert J.

doi:10.1016/s0041-1345(00)02503-3

Cited by 18 publications

(15 citation statements)

References 2 publications

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“…Finally 7 citations [9,10,[13][14][15][16][17] , including 521 patients, were included in our study ( Figure 1). Of these 7 studies, one used tranexamic acid in the control group [16] ; two studies contained two aprotinin groups, a high dose group and a routine dose group [10,15] ; one study contained two control groups [17] ; and two studies used the same sample [10,15] , the size of which was calculated only once.…”

Section: Recording Of Datamentioning

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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Section: Recording Of Datamentioning

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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“…These prospective studies have shown that the prophylactic use of aprotinin reduces blood transfusion requirements in liver transplant recipients by about 30% [51, 52, 54]. In addition to this, aprotinin has potent anti-inflammatory properties which may explain the improved hemodynamic stability, lower plasma levels of interleukin-6, and better outcome in patients who have received aprotinin, compared to placebo [11,55,56,57,58]. No increased risk of thromboembolic complications has been shown in any of the randomized controlled trials.…”

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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“…Furthermore, 1‐month graft survival was significantly higher in patients who received aprotinin (0 / 89 requiring retransplantation within 1 month) than in patients in the placebo group (4 / 48 requiring retransplantation). One‐month recipient survival rate was similar among the 3 groups 34…”

Section: Aprotininmentioning

confidence: 73%

“…Use of aprotinin is certainly supported by many prospective trials and its potential antiinflammatory and antioxidant effects also seem attractive during OLT 29–34. However, it is more expensive compared to other antifibrinolytics and its nonantifibrinolytic effects and its clinical significance need to be confirmed in future studies.…”

Section: Indications Contraindications and Drug Selectionmentioning

confidence: 99%

Antifibrinolytics in orthotopic liver transplantation: Current status and controversies

Xia

Steadman

2004

Liver Transpl

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This article reviews the current status and controversies of the 3 commonly used antifibrinolytics-epsilon-aminocaproic acid, tranexamic acid and aprotinin-during liver transplantation. There is no general consensus on how, when or which antifibrinolytics should be used in liver transplantation. Although these drugs appear to reduce blood loss and decrease transfusion requirements during liver transplantation, their use is not supported uniformly in clinical trials. Aprotinin has been studied more extensively in clinical trials and appear to offer more advantages compared to two other antifibrinolytics.

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Improved early graft survival in patients receiving aprotinin during orthotopic liver transplantation

Cited by 18 publications

References 2 publications

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

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

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

Antifibrinolytics in orthotopic liver transplantation: Current status and controversies

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