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[Reduction of the need for blood derivatives in liver transplantation using aprotinin]
P Monedero1, J A Páramo, F Carrascosa
1Departamento de Anestesiología y Reanimación, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra, Pamplona.
Objectives:
To evaluate the efficacy of aprotinin in reducing the need for blood products in orthotopic liver transplantation.
Patients And Methods:
Blood product needs and coagulation test results were studied in 42 adults with cirrhosis of the liver who received orthotopic liver transplants. The first 16 liver transplants carried out without aprotinin (control group) were compared with the next 26 consecutive transplant patients who received aprotinin. Each of the first 9 received a loading dose of 2 million units that was followed by the infusion of half a million units per hour until the end of surgery. The next 17 received the same infusion dose at the same rate but no loading dose.
Results:
Patients who received aprotinin required fewer transfusions of blood products (5.3 units of packed red blood cells as opposed to 13 units; 9 units of fresh frozen plasma versus 14.6 units; 1.7 units of platelets versus 4.2 units; and 3.8 units of cryoprecipitates versus 8.8 units). We observed a marked reduction of fibrinolysis (less increase in D dimers after removal of the liver when aprotinin was used.
Conclusions:
Prophylactic use of aprotinin during surgery has a beneficial effect on hemostatic mechanisms, reducing the need for blood products. A reduction in fibrinolysis seems to contribute to this effect.