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Thromb Haemost 1993; 69(01): 025-028
DOI: 10.1055/s-0038-1651542
Original Article
Coagulation
Schattauer GmbH Stuttgart

Intravascular Coagulation in Liver Transplantation – Is It Present or Not?

A Comparison between Orthotopic and Heterotopic Liver Transplantation
C M Bakker
1   The Department of International Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
2   The Department of Hematology, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
H J Metselaar
1   The Department of International Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
M J Gomes
2   The Department of Hematology, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
R J Porte
1   The Department of International Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
Th N Groenland
3   The Department of Anesthesiology, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
S W Schalm
1   The Department of International Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
O T Terpstra
4   The Department of Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands
,
J Stibbe
2   The Department of Hematology, University Hospital Dijkzigt, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received 12 June 1992

Accepted after revision 19 August 1992

Publication Date:
04 July 2018 (online)

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Summary

It is still not clear whether disseminated intravascular coagulation (DIC) contributes to the hemostatic disturbances in orthotopic liver transplantation (OLT). Theoretically the lack of hepatic clearance of procoagulant factors during the anhepatic period and the release of thromboplastic material from the graft might trigger DIC. During heterotopic liver transplantation (HLT) the host liver is left in situ and procoagulant factors may still be cleared; DIC, if present, may not occur until after reperfusion. The aim of the present study was to gain more insight into the underlying mechanism of the coagulation changes during liver transplantation by comparison of OLT and HLT. Thrombin-antithrombin-III complexes (TAT), and indicator of thrombin generation, fibrin degradation products (FbDP) and routine clotting times were assayed in 12 OLTs, 18 HLTs and in a control group of 10 partial hepatic resections (PHR).

TAT increased dramatically after reperfusion to 136 μg/l in OLT and to 94 μg/l in HLT (p n.s.). In contrast, FbDP levels increased only in OLT, to a maximum of 13.8 μg/ml. Routine clotting times changed mildly and similarly in both OLT and HLT.

Conclusions: Graft reperfusion triggers excessive thrombin formation, but there are no other signs of subsequent DIC. Any thrombin formed is probably rapidly inhibited by antithrombin-III. The rise in FbDP during OLT is the result of increased fibrinolysis, which occurred only in OLT and not in HLT.

 

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