Massive ascitic fluid loss and coagulation disturbances after liver transplantation.
OBJECTIVE
A unique syndrome in which massive ascitic fluid loss developing 1-4 weeks after orthotopic liver transplantation (OLT) was associated with a hypercoagulable state and thrombotic complications is described. After OLT, severe coagulation abnormalities (international normalized ratio, 4.6) developed in a patient with ascitic losses of up to 12 L/day. The patient developed hypovolemia and severe systemic antithrombin III deficiency and venoocclusive disease in the graft. The aim of this study was to determine the prevalence of this syndrome after OLT.


METHODS
Coagulation studies were performed in 25 additional patients with large ascitic fluid losses after OLT and in 7 cirrhotic patients not undergoing transplantation.


RESULTS
All transplant recipients developed systemic deficiencies of multiple coagulation factors including antithrombin III. Markers of prothrombin activation were significantly elevated in both ascites and serum in all patients, and thrombotic complications subsequently developed in 5 patients. In the 7 cirrhotic patients, markers of prothrombin activation remained normal or minimally elevated and thrombotic complications were not found.


CONCLUSIONS
Massive ascitic losses after OLT may lead to a hypercoagulable state from unreplaced losses of plasma coagulation factors into ascites and accumulation of thrombin in the systemic circulation. Hypovolemia and major coagulation abnormalities should be corrected with fresh frozen plasma, which may prevent the development of thrombotic complications.
Gane
E
E
Institute of Liver Studies, King's College Hospital, London, England.
Langley
P
P
Williams
R
R
D000328:Adult; D020152:Antithrombin III Deficiency; D001201:Ascites / Q000378:metabolism*; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001779:Blood Coagulation Factors / Q000032:analysis; D001810:Blood Volume; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D011183:Postoperative Complications; D013577:Syndrome
D001779:Blood Coagulation Factors