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Liver transplantation: Intraoperative changes in coagulation factors in 100 first transplants
Author(s) -
Lewis Jessica H.,
Bontempo Franklin A.,
Awad Sami A.,
Kang Yoo Goo,
Kiss Joseph E.,
Ragni Margaret V.,
Spero Joel A.,
Starzl Thomas E.
Publication year - 1989
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840090509
Subject(s) - medicine , liver transplantation , cirrhosis , gastroenterology , fulminant , coagulation , prothrombin time , clotting factor , fibrinogen , primary sclerosing cholangitis , hepatocellular carcinoma , transplantation , surgery , disease
Six intraoperative blood samples were obtained at intervals from each of 100 individuals undergoing their first liver transplants. The patients fell into the following diagnostic categories: postnecrotic cirrhosis 28, primary biliary cirrhosis 20, sclerosing cholangitis 19, miscellaneous diseases 14, carcinoma/neoplasia 12 and fulminant hepatitis 7. Coagulation factor values in the initial (baseline) blood samples varied by patient diagnosis. In general, all factor levels were reduced except factor VIII:C, which was increased to almost twice normal. The slight intraoperative changes in factors II, VII, IX, X, XI and XII suggested that a steady‐state relationship existed between depletion (consumption/bleeding) and repletion (transfusion, transit from extra‐ to intravascular space), even in the anhepatic state. In contrast, there were rapid and very significant falls in factor VIII and fibrinogen and a less pronounced decrease in factor V, all reaching their nadirs in early to mid‐Stage III. The cause of these coagulation changes appears to be activation of the fibrinolytic system.