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Aberrations in hemostasis and coagulation in untreated discordant hepatic xenotransplantation: Studies in the dog‐to‐pig model
Author(s) -
Tector A. Joseph,
Fridell Jonathan A.,
Elias Nahel,
Watanabe Taichi,
Salazar Julie,
Greinke Doris,
Metrakos Peter,
Tchervenkov Jean I.
Publication year - 2002
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2002.30881
Subject(s) - xenotransplantation , medicine , hemostasis , coagulation , clotting factor , platelet , liver transplantation , coagulopathy , transplantation , pathology
Discordant liver xenotransplantation is a poorly explored entity. Data from the few large animal studies of hepatic xenotransplantation suggest that severe hemorrhage is encountered. The purpose of the studies described here is to characterize the nature of the hemorrhage that accompanies liver xenotransplantation. Canine livers were transplanted into porcine recipients, and lethal hemorrhage was encountered. Analysis of recipient blood showed that factors V, IX, and X were present in adequate levels until after the hemorrhage appeared, suggesting that coagulation factor loss was the result and not the cause of hemorrhage. Platelet counts decreased dramatically in recipients within minutes of graft reperfusion. There also was no evidence of clotting activity in the blood of recipients of liver xenografts within minutes of graft reperfusion. This loss of clotting activity was specific to liver xenografts, was not seen in renal xenografts with or without venovenous bypass, and also was absent in pig‐to‐pig liver allografts. In brief, the hemorrhage that accompanies liver xenotransplantation occurs because of a decrease in the number and function of circulating platelets in the recipient.