Laboratory monitoring of the haemostatic system changes during orthotopic liver transplantation

In liver diseases, all components of the haemostatic system are changed and the degree of dysfunction is proportional to hepatocellular damage. During the liver transplantation, values of haemostatic parameters show substantial changes, while postoperatively there is a gradual normalisation of the haemostatic system function.

The aim was to monitor the changes of the haemostatic system intraoperatively and postoperatively, including the dynamics at which physiological values of parameters are reached after transplantation.

There were 17 cadaveric transplantations performed at the Clinical Centre of Vojvodina in the period from June 2008 to February 2012. The following parameters were tested: platelets, activated partial thromboplastin, prothrombin and thrombin time, fibrinogen, euglobulin clot lysis time, D-dimer, antithrombin and heparinemia.The results were presented intraoperatively in phases of transplantation, and postoperatively from day 1 to day 7, ending with postoperative day 14.

During transplantation, the most pronounced disorders among those observed are: thrombocytopenia (96 +/- 66.1 x 10(9)/L), prolonged activated partial thromboplastin (1.80 +/- 0.8 R), prothrombin (1.59 +/- 0.4 R) and thrombin time (2.03 +/- 1.7 R), hypofibrinogenemia (2.13 +/- 0.5 g/L), hyperfibrinolysis (29 +/- 12.0 min), increase of D-dimer (1393 +/- 1220.4 ng/mL) and decrease of antithrombin (61 +/- 18.0%). Further monitoring after transplantation from postoperative day 1 revealed a gradual normalisation in the values, reaching physiological values for all parameters on postoperative day 14, except for the sustained high value of D-dimer (2606 +/-1055.1 ng/mL). Heparinemia was within the prophylactic range (0.26 +/- 0 IU/mL).

Thorough monitoring of the haemostatic system parameters in liver transplantations is of great importance, as it enables the use of optimal substitution therapy during and after transplantation, as well as an adequate postoperative thromboprophylaxis. Our study has shown normalisation of investigated laboratory parameters within 7-14 days after transplantation.