Coagulation and fibrinolysis in the first human auxiliary partial liver transplantation in rotterdam

Abstract

Coagulation and fibrinolysis parameters were extensively monitored during and after a case of auxiliary partial liver transplantation (APLT). Preoperative coagulation tests demonstrated a severe liver dysfunction. Routine coagulation tests were prolonged and low levels of fibrinogen, antithrombin III (AT-III), and ( α 2-antiplasmin ( α 2-AP) were measured. Pro-urokinase (pro-UK), total Uk-antigen and plasminogen activator inhibitor (PAI) activity were increased (6.2; 5.4 ng/ml and 12.5 IU/ml, respectively). During transplantation no major changes in haemostasis were detected by either standard coagulation tests or thrombelastography and only a minimal increase of fibrinogen degradation products (0.6–1.0 μg/ml) was seen just before graft recirculation up till the end of the operation. PAI levels remained high during the operation and neither tissue-type plasminogen activator (t-PA) nor active urokinase (u-PA) were detectable. After APLT, graft function was reflected by normalisation of coagulation parameters and increase of AT-III and α 2-AP to normal levels. Pro-Uk and PAI activity levels decreased after transplantation to normal values; a transient increase of t-PA activity (max. 1360 mIU/ml) was seen from the tenth to nineteenth day. It was demonstrated that a heterotopically placed partial liver allograft can provide synthesis of haemostasis factors and inhibitors and restore clearance which is adequate to reverse coagulopathy.