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Disorders of coagulation and fibrinolysis are well known phenomena after exvivo xenogeneic liver perfusion. However, their mechanisms have not been clear so far.This study is on the coagulation and fibrinolysis in clinical and experimental ex-vivo xenogeneic liver perfusion.Materials and Methods: Donor liver was taken out from a porcine weighing 10-14kg under intravenous anesthesia, which had been prepared preoperatively by antibioticus for one week, then it was washed out with chilled lactated Ringer's solution via portal vein and hepatic artery. The isolated porcine liver was perfused by an adult mongrel dog experimentally. The same procedures were clinically applied for a patient suffering from hepatic coma. The coagulation and fibrinolysis were avaluated using following various parameters.Results: A. Experimental studies; RBC was not changed during perfusion. WBC decreased 50% during 2 hour-perfusion. Platelet count markedly decreased (60-80%) within 30 minutes after perfusion and this low level continued for 2 hours. Fibrinogen level showed 30 to 50% decrease within one hour, 50 to 80% decreasing after 2 hour-perfusion. PT after 2 hour-perfusion was 60-15%, PTT was 60-50%, after 2 hours. No active plasmin was found through out the perfusion. SK+plasmin and whole plasmin level did not show any changes. However, FDP after 30 minute-perfusion was 30-60ng/ml.B. Clinical cases; Prior to the perfusion the platelet count was 46, 000, platelet aggregation was 48.1%, PT was 22.4%, PTT was 10%, TT was 10.5%, and HPT was 5%. After 2 hour-perfusin the platelet count was 28, 000 and platelet aggregation began to increase 30 minutes after perfusion up to 75.3% in 2 hours. Fibrinogen which had been 155mg/dl prior to the perfusion decreased to 92mg/dl after perfusion. PT, PTT, HPT, and ELT did not change during perfusion. The active plasmin level showed negative up to one hour and 30 minutes, however, it changed to positive within next 30 minutes. Prior to the perfusion the FDP was 200ng/dl and did not change during the perfusion.Conclusion: In the porcine liver which was perfused by recipient dog, a clotting formation was found in each case during first 30 minutes perfusion. The same change was found in the clinical case. This hypercoagulability and clotting formation are assumed to be the result of hyper acute rejection induced by antibody-leuco plugging and antibody-thromboplugging.

A clinical and experimental study on coagulation and fibrinolysis during ex-vivo xenogeneic liver perfusion