The intra-operative use of trasylol (aprotinin) in liver transplantation.
Aprotinin has been reported to reduce blood loss in difficult cases requiring cardiopulmonary bypass surgery and more recently in liver transplantation. Over a 9-month period we compared the effects of an intra-operative infusion of aprotinin on transfusion requirements and coagulation profiles in 12 patients undergoing liver transplantation for end-stage cirrhosis with an equal number of consecutive transplants in patients with similar pathology who did not receive aprotinin. Transfusion of blood and blood products was reduced to one-third in the aprotinin-treated group. Operative time was also significantly reduced, as was ICU stay post-operatively. Aprotinin profoundly inhibits fibrinolysis and this is likely to be the major effect by which blood loss is reduced. Thromboelastography revealed severe fibrinolytic changes in the anhepatic stage in 4 of 6 controlled patients; this accelerated in 3 following reperfusion of the new graft. By contrast, only 1 patient of 12 in the aprotinin-treated group showed fibrinolytic activity in the anhepatic period, and none showed evidence of fibrinolysis following reperfusion of the new graft.
Mallett
S V
SV
Department of Anaesthesia, Royal Free Hospital and School of Medicine, Hampstead, London, UK.
Cox
D
D
Burroughs
A K
AK
Rolles
K
K
D007611:Aprotinin / Q000627:therapeutic use*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005342:Fibrinolysis; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation; D012712:Serum Globulins / Q000276:immunology; D013916:Thrombelastography; D010959:Tissue Plasminogen Activator / Q000097:blood
D012712:Serum Globulins; D007611:Aprotinin; D010959:Tissue Plasminogen Activator