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Plasma proteolytic activity in liver transplant rejection
T Scholz1, M J Gallimore, L Bäckman
1Institute for Surgical Research and Surgical Department B, Rikshospitalet, The National Hospital, Oslo, Norway.
Summary
Proteolytic enzyme systems, including coagulation and fibrinolysis, are activated during liver transplantation. These systems showed more activity in patients with uneventful recovery than those experiencing acute rejection.
Area of Science:
- Biochemistry
- Transplantation Immunology
- Hemostasis and Thrombosis
Background:
- Proteolytic enzymes are crucial in hemostasis and thrombosis.
- Orthotopic liver transplantation (OLT) involves complex physiological changes.
- Understanding early postoperative proteolytic activity is vital for patient outcomes.
Purpose of the Study:
- To investigate the role of coagulation, fibrinolytic, and plasma contact systems in early OLT recovery.
- To compare proteolytic enzyme activity between patients with acute rejection (AR) and those with uneventful courses.
Main Methods:
- Studied 29 patients undergoing OLT, collecting daily blood samples for 2 weeks post-surgery.
- Measured kallikrein-like activity (KK), functional kallikrein inhibition (KKI), plasmin-like activity (PL), and alpha2-antiplasmin (AP).
- Assessed prekallikrein (PKK), prothrombin (PTH), antithrombin III (AT III), plasminogen (PLG), TAT, F1 + 2, and PAP levels.
Main Results:
- Coagulation, fibrinolytic, and plasma contact systems were activated during OLT.
- Continuous thrombin and plasmin generation occurred post-OLT.
- Higher thrombin and plasmin generation was observed in patients with uneventful recovery compared to those with AR.
Conclusions:
- Proteolytic systems are significantly activated in the early postoperative phase of OLT.
- The degree of thrombin and plasmin generation may differentiate between uneventful recovery and AR.
- Proteolytic activity warrants further investigation in OLT management.