Plasma proteolytic activity in liver transplant rejection

Abstract

In this study, we evaluated the role of proteolytic enzymes belonging to the coagulation, fibrinolytic, and plasma contact systems in the early postoperative phase after orthotopic liver transplantation (OLT). Twenty-nine patients were studied at the time of OLT and during the first 2 postoperative weeks. Blood samples were collected daily after OLT and analyzed for kallikrein-like activity (KK), functional kallikrein inhibition (KKI), plasmin-like activity (PL), and a,-antiplasmin (AP). In addition, prekallikrein (PKK), prothrombin (PTH), antithrombin I11 (AT III), plasminogen (PLG), prothrombiniantithrombin I11 complexes (TAT), prothrombin fragment 1 + 2 (F 1 + 2), and plasminla,-antiplasmin complexes (PAP) were measured. Nineteen patients experienced biopsy-verified acute rejections (AR) and ten patients had uneventful courses and served as controls. Plasma analyses showed that the contact, coagulation, and fibrinolytic systems were activated during OLT. Following OLT, continuous thrombin and plasmin generation was observed, and these effects were more pronounced in the group having an uneventful course than in patients with AR. Factors that could possibly affect plasma proteolytic activity, such as blood product usage during and after OLT and cold ischemia time of the liver graft, did not differ between the groups, nor did the routine liver function tests, alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

The significance of heparin-coated veno-venous bypass circuits in liver transplantation

“…These observations, indicating ongoing activation of the coagulation and fibrinolytic systems during and after OLT, are in accordance with earlier reports by our group. 23 KK-like activities were increased significantly 5 min after revascularization of the liver graft, as described earlier. 15 Mediators of leukocyte activation have been reported to be of importance in the activation of coagulation in the reperfusion phase in OLT.…”

Evaluation of the coagulation and inflammatory responses in solid organ transplant recipients and donors

“…Similarly, acute rejection has been associated with activation of the inflammatory and coagulation cascades in the immediate post-operative period. Thrombotic microangiopathy has been seen in human renal transplantation and xenotransplantation during allograft rejection (23)(24)(25)(26).…”