ABSTRACT
Background: Living related liver transplantation is an established line of treatment for end stage liver disease. Massive transfusion is a frequent practice in this procedure. A variety of coagulation abnormalities may complicate the post-operative period
Patients and methods: The study was conducted in Mansoura University between May 2004 and July 2006. 21 patients were included in the study. Time of normalization [TON] of 7 coagulation parameters [prothrombin concentration, international normalization ratio, activated partial thromboplastin time, platelet count, factor V, VII and fibrinogen concentration] to predefined normalization cutoff limits were recorded. Mean of normalization times of 6 of these parameters [excluding platelets] was calculated as overall normalization time [ONT]. These times were then compared between two pairs of groups based on either total intraoperative blood transfusion [average transfusion AT Vs massive transfusion MT groups or intraoperative colloid/blood infusion ratio [Low colloid/blood LCB Vs high colloid/blood HCB] groups. Correlation analysis was performed to test association between intra-operative replacement protocol and post-operative coagulation profile
Results: Patients with higher pre-operative MELD score had more intra-operative blood components transfusion [absolute and compared to colloids]. Apart from ONT 5, which was significantly longer in the MT and LCB groups compared to AT and H08 groups, no significant differences were observed between each pair of groups. Significant linear correlation existed between ONT and total blood components transfusion volume
Conclusion: The recorded TON of coagulation system components favours the start of prophylactic anti-coagulants after the 3rd post-operative day in absence of clinically significant bleeding. The pre-operative and intra-operative conditions are not appropriate alone to anticipate the time by which the coagulation system will be normalized making thrombosis a risk