Mediators of fibrinolysis in orthotopic liver transplantation

Activation of fibrinolysis remains a clinical problem in orthotopic liver transplantation. We have measured tissue plasminogen activator (t-PA), plasmin and alpha-2-anti-plasmin (alpha 2AP) activities in plasma from 10 patients undergoing elective transplantation. t-PA activity increased during the anhepatic phase and immediately after graft reperfusion (p > 0.001). This increase could not be attributed to t-PA released by the donor liver. Overall transfusion requirements did not relate with either t-PA or alpha 2AP activities individually, but were strongly correlated with the ratio t-PA/ alpha 2AP (p > 0.02). These results suggest that routine prophylactic use of antifibrinolytic agents may be beneficial.