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
ABSTRACT
Immunological factors are important in the pathogenesis of a wide spectrum of hepatobiliary diseases. Using flow cytometry, we determined the changes in lymphocyte subsets and natural killer cells in 123 individuals [81 patients with liver disease and 42 healthy volunteers]. The liver diseases included periportal fibrosis [PPF, 10 patients]. liver cirrhosis [LC, 31 patients], and hepatocellular carcinoma [HCC, 40 patients]. Schistosomiasis and viral hepatitis B and C were the putative etiological agents of liver diseases. Immunophenotyping by indirect immunofluorescence was conducted using monoclonal antibodies to CD3 [T-lymphocytes], CD4 [helper/inducer T-cells], CD8 [suppressor/cytotoxic T-cells] and CD 57 [natural killer cells] cell surface markers. Immunophenotyping of PPF patients showed no significant changes in all markers compared with the healthy controls. However, there was a significant decrease [P<0.01] in CD3 and CD4 T-cells, and a highly significant increase [P<0.001] in CD 57 T-cells in patients with LC or HCC. In addition, LC and HCC patients showed no significant change in CD8 T-cells compared with controls. The progression of liver diseases is associated with a dysregulation of cellular immune responses. T-lymphocytes and natural killer cells may play a role in the immunopathogenesis of LC and HCC