role of recombinant factor VII in controlling the intraoperative blood loss in patients with severe coagulopathy and portal hypertension during living donor liver transplant surgery

ABSTRACT

Liver transplantation is the standard form of treatment for patients with end stage liver disease, with the use of blood product as a standard method for transfusion. Recombinant factor Vila [rVlla] may help those patients to acquire less amount of transfusion. This will have an impact not only the morbidity and mortality of the recipient and the donor, but also on the economical aspect of this tremendously expensive procedure. We conducted this study to verify the possible beneficial effects of using rVlla at a lower dose than the standard dosage, which could have an impact on the future use of rVlla. Twenty-four patients scheduled for orthotropic livertransplantation, divided into 2 groups; a control group and an rVlla group. Both groups received the same anesthetics enlisted in our protocol for liver transplantation. The rVlla group received a loading dose of 30 microg/kg of rVlla following the induction of anesthesia, followed by a maintenance dose of 5 microg / kg until the end of the dissection phase. Demographic data, coagulation profile [prothrombin time [PT], prothrombin concentration [PC], partial thromboplastin time [PTT], International normalized ratio [INR]], blood loss, transfusion requirements, the duration of the dissection phase, the duration of surgery, hemoglobin concentration [Hb], and platelet count were done immediately after induction and 1, 2, 3 and 6 hours post induction [dissection phase]. Finally, a Doppler assessment of the graft vessels was performed subsequent to anastomosis. The rVlla group had a lower PT in the first two hours of the dissection phase in relation to the baseline and significantly lower than the control group [P = 0.0002]. The INR showed a significant improvement in the rVlla group during the dissection phase compared to the control group, and during the first two hours compared with the baseline in the rVlla group [P = 0.0002]. When compared to the control group, the rVlla group had a significant increase in the platelet count, in all samples taken during the dissection phase. There was a significant decrease in the intraoperative requirements of packed red blood cells [P = 0.014], platelets [P = 0.0005] and fresh frozen plasma [P = 0.01] in the rVlla group compared to the control group. We conclude that administering low dose of rVlla would be helpful during liver transplantation surgery. Improvement in the coagulation profile, transfusion requirements, and consequently postoperative morbidity and mortality could be achieved