title: Liver transplantation: intraoperative changes in coagulation factors in 100 first transplants.
abstract: Six intraoperative blood samples were obtained at intervals from each of 100 individuals undergoing their first liver transplants. The patients fell into the following diagnostic categories: postnecrotic cirrhosis 28, primary biliary cirrhosis 20, sclerosing cholangitis 19, miscellaneous diseases 14, carcinoma/neoplasia 12 and fulminant hepatitis 7. Coagulation factor values in the initial (baseline) blood samples varied by patient diagnosis. In general, all factor levels were reduced except factor VIII:C, which was increased to almost twice normal. The slight intraoperative changes in factors II, VII, IX, X, XI and XII suggested that a steady-state relationship existed between depletion (consumption/bleeding) and repletion (transfusion, transit from extra- to intravascular space), even in the anhepatic state. In contrast, there were rapid and very significant falls in factor VIII and fibrinogen and a less pronounced decrease in factor V, all reaching their nadirs in early to mid-Stage III. The cause of these coagulation changes appears to be activation of the fibrinolytic system.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: J H
authors.initials: JH
authors.lastname: Lewis
authors.forename: F A
authors.initials: FA
authors.lastname: Bontempo
authors.forename: S A
authors.initials: SA
authors.lastname: Awad
authors.forename: Y G
authors.initials: YG
authors.lastname: Kang
authors.forename: J E
authors.initials: JE
authors.lastname: Kiss
authors.forename: M V
authors.initials: MV
authors.lastname: Ragni
authors.forename: J A
authors.initials: JA
authors.lastname: Spero
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000293:Adolescent; D000328:Adult; D001779:Blood Coagulation Factors / Q000032:analysis*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D015209:Cholangitis, Sclerosing / Q000097:blood; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000097:blood; D008105:Liver Cirrhosis, Biliary / Q000097:blood; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D001779:Blood Coagulation Factors