Heparin as the cause of coagulopathy which may complicate grafting of the liver.
Disposal of heparin is accomplished rapidly by the normal liver, but the effects of ischemia, flushing and hypothermia during hepatic transplantation have not been investigated before. The results of the present study showed that neither laparotomy, hypothermia nor insertion of the portosystemic bypass seemed markedly to affect the coagulation profile, but autograft associated with 30 to 45 minutes of warm ischemia resulted in a twofold prolongation of the t1/2 heparin as calculated from sequential measurements of the activated clotting time. Unexpectedly, the storage of livers for four hours in EuroCollins solutions seemed to result in more rapid disappearance of heparin than in animals after laparotomy. After hepatectomy, the clearance of heparin was delayed for two hours but, thereafter, the slope of the disappearance resembled that in sham operated animals. Autograft and allograft of livers in normal pigs that did not receive transfusion were also associated with changes in fibrinolysis and declining levels of fibrinogen together with severe intraoperative bleeding problems and rapid death on the operating table in 30 per cent of the pigs. While administration of heparin alone did not appear to precipitate these changes, use of the drug after dissection, mobilization and storage of the liver may release other tissue factors that activate fibrinolysis.
Hickman
R
R
Department of Surgery, University of Cape Town, South Africa.
Bracher
M
M
Pienaar
B H
BH
Jacobs
P
P
Bird
A R
AR
Terblanche
J
J
D000818:Animals; D001778:Blood Coagulation Disorders / Q000209:etiology*; D005069:Evaluation Studies as Topic; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis; D006493:Heparin / Q000097:blood*; D006498:Hepatectomy; D007036:Hypothermia, Induced; D007511:Ischemia / Q000150:complications; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods; D010976:Platelet Count; D013552:Swine; D013997:Time Factors; D014914:Whole Blood Coagulation Time
D005340:Fibrinogen; D006493:Heparin