Hemorrhagic features and the application of recombinant activated factor Ⅶ in liver transplantation / 中国组织工程研究

ABSTRACT

BACKGROUND: Hemorrhage, hemostasis, and blood coagulation, as well as the application of hemostasis measures, in the liver transplantation have been poorly understood. There have been no protocols regarding routine hemostasis.OBJECTIVE: To investigate the hemorrhagic features in each phase and to observe the application efficacy of recombinant activated factor Ⅶ (rFⅦ a) during the liver transplantation.DESIGN, TIME AND SETTING: A retrospective case analysis, controlled observation experiment was performed at the Department of Common Surgery, Second Affiliated Hospital of Sun Yat-sen University between April 2001 and July 2006.PARTICIPANTS: Fifteen patients who received liver transplantation between April 2001 and March 2003 served as retrospective study subjects. An additional 28 patients who underwent liver transplantation between March 2003 and July 2006 were randomly and evenly divided into two groups rFⅦ a and control.METHODS: The hemorrhage rule of 15 patients who received liver transplantation in the protophase was retrospectively analyzed and the hemorrhagic feature in each time period was localized. A comparative observation was performed in the 28 patients in the anaphase. The rFⅦ a group received an intravenous injection of 70-80 μ g/kg rFⅦ a for 3-5 minutes. Simultaneously, the control group was given 50 m/physiological saline in parallel.MAIN OUTCOME MEASURES: Hemorrhage volume of 15 patients that received liver transplantation in each phase; prothrombin time, activated partial thromboplastin time, and total hemorrhage volume prior to and 30 minutes after rFⅦa application in 14 patients who received liver transplantation.RESULTS: Extensive errhysis was a primary cause of hemorrhage in the liver transplantation. Hemorrhage pdmadly occurred in the phase of diseased liver resection (i.e., pre-anhepatic phase), rFⅦ a could well improve various coagulation functional indices, i.e., thromboelastography indices (reaction time, coagulation time, α angle, and maximum amplitude) and routine blood indices (prothrombin time and activated partial thromboplastin time). Compared with the control group, hemorrhage volume was obviously decreased and transplantation time was significantly shorter in the rFⅦa group. In addition, no thrombotic complications were found in the rFⅦa group during the observation period.CONCLUSION: The pre-anhepatic phase is a primary hemorrhage phase during the liver transplantation, rFⅦ a can be successfully applied for liver transplantation.