Coagulation plasma factor levels are early indicators of graft nonfunction following liver transplantation in children.
Following liver transplantation, the decision to retransplant in cases in which graft function is marginal must be taken early. Plasma coagulation factor monitoring was evaluated as an early predictor of graft failure requiring retransplantation in the first posttransplant week. Plasma levels of fibrinogen, factors V, VII, VIII, IX, antithrombin III, protein C, and plasminogen were measured in all patients at 0, 12, 24, 48, 72, 96, and 120 hours posttransplant in 46 patients who received 56 grafts and results were compared between livers that failed early (group 1) and those that functioned adequately (group 2). Six grafts were included in group 1: one patient died before retransplantation, four were retransplanted once, and one patient was retransplanted twice. Three grafts had primary nonfunction (PNF), 2 had obstructed portal veins, and 1 had a long period of warm ischemia during the initial transplant. In group 1, plasma levels of factor V were significantly lower than in group 2 at 24, 48, and 72 hours posttransplant (21.2% +/- 14.2%, 12.4% +/- 4.5%, and 13.0% +/- 5.0% v 39.1% +/- 23.9%, 48.8% +/- 31.9%, and 60.9% +/- 25.9%; P less than .05, P less than .01, and P less than .005, respectively). Similarly, plasma levels of factor VII were significantly lower in group 1 over the same period of time (7.3% +/- 2.7%, 4.2% +/- 1.8%, and 4.7% +/- 2.5% v 27.4% +/- 17.1%, 34.1% +/- 21.6%, and 34.8% +/- 18.6%, respectively; P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)
Bilik
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Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Superina
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Poon
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D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005164:Factor IX / Q000032:analysis*; D005165:Factor V / Q000032:analysis*; D005167:Factor VII / Q000032:analysis*; D005169:Factor VIII / Q000032:analysis*; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D012086:Reoperation; D013997:Time Factors
D015415:Biomarkers; D005165:Factor V; D005167:Factor VII; D005169:Factor VIII; D005164:Factor IX