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Coagulation disorder during liver transplantation.

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Liver transplantation patients experiencing major bleeding showed lower platelets, fibrinogen, and clotting factors, alongside fibrinolysis. These haemostatic changes, including fibrinolysis and clotting activation, correlate with operative hemorrhage during liver transplants.

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Area of Science:

  • Transplantation Medicine
  • Haematology
  • Surgical Pathology

Background:

  • Liver transplantation is a complex procedure associated with significant haemostatic challenges.
  • Understanding coagulopathy during liver transplantation is crucial for patient management and outcomes.

Purpose of the Study:

  • To investigate detailed haemostatic changes during liver transplantations.
  • To correlate haemostatic abnormalities with the extent of operative bleeding.

Main Methods:

  • Prospective study of eight liver transplantations, divided into minor (Group 1) and major (Group 2) bleeding groups.
  • Analysis of haemostatic parameters including platelet count, fibrinogen, clotting factors (V, VII), alpha 2-antiplasmin, and thromboelastography.
  • Monitoring of plasma levels of tissue plasminogen activator, thrombin-antithrombin III complex, protein C, protein S, antithrombin III, and plasminogen.

Main Results:

  • Major bleeding (Group 2) was associated with significantly lower levels of platelets, fibrinogen, factor V, and alpha 2-antiplasmin compared to minor bleeding (Group 1).
  • Thromboelastography indicated fibrinolysis in Group 2, with a slight increase in tissue plasminogen activator in both groups.
  • Post-reperfusion, reductions in PT, fibrinogen, FV, and FVII, alongside prolonged PTT and increased thrombin-antithrombin III complex, were observed.

Conclusions:

  • Pre-existing fibrinolysis followed by clotting system activation are primary drivers of coagulopathy in liver transplantation.
  • These haemostatic derangements correlate with operative blood loss and observed abnormalities in haemostatic tests.