title: The significance of heparin-coated veno-venous bypass circuits in liver transplantation.
abstract: We studied the effects of veno-venous bypass (VVBP) circuit surface heparinization on the activation of the plasma defence systems (coagulation, fibrinolysis, kallikrein-kinin and complement) and leukocyte activation in a prospective randomized study in 20 patients during and 1 day after liver transplantation (OLT). To our knowledge, this is the first study of this kind where the possible benefits of surface heparinization of the VVBP circuit in OLT have been investigated. Twenty patients were randomized to either heparin-coated (HC) VVBP equipment or to otherwise identical noncoated (NC) circuits. Five blood samples were drawn during the OLT procedure: one just before VVBP, three during VVBP and one 5 min after portal venous reperfusion (PVR). A further sample was taken 1 day after the operation. Components of the blood coagulation, fibrinolytic and kallikrein-kinin systems were analysed using functional assays (chromogenic peptide substrate assays) or enzyme immunoassays (EIA). Complement system factors and granulocyte activation, represented by myeloperoxidase (MPO) release, were analyzed by EIA. Activation of the plasma defence systems occurred in both groups at an early stage during OLT and a further activation occurred 5 min after PVR. MPO levels were slightly elevated 5 min after PVR. However, no significant differences between the two groups were observed. Significant activation of the humoral defense systems was found in both groups during OLT. A considerably larger study, including at least 330 patients, is necessary to fully assess the possible benefits of surface heparinization of the VVBP circuit.
authors.affiliation: Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo, Norway.
authors.forename: Tim
authors.initials: T
authors.lastname: Scholz
authors.forename: Rigmor
authors.initials: R
authors.lastname: Solberg
authors.forename: Cecilie
authors.initials: C
authors.lastname: Okkenhaug
authors.forename: Vibeke
authors.initials: V
authors.lastname: Videm
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gallimore
authors.forename: Oystein
authors.initials: O
authors.lastname: Mathisen
authors.forename: Tom E
authors.initials: TE
authors.lastname: Mollnes
authors.forename: Anstein
authors.initials: A
authors.lastname: Bergan
authors.forename: Odd
authors.initials: O
authors.lastname: Søreide
authors.forename: Göran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Ansgar O
authors.initials: AO
authors.lastname: Aasen
mesh_terms: D000293:Adolescent; D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects; D020099:Coated Materials, Biocompatible / Q000494:pharmacology*; D003165:Complement System Proteins / Q000378:metabolism; D016207:Cytokines / Q000097:blood; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006098:Granulocytes / Q000187:drug effects / Q000378:metabolism; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000187:drug effects
chemical_list: D020099:Coated Materials, Biocompatible; D016207:Cytokines; D006493:Heparin; D003165:Complement System Proteins