Recombinant human coagulation factor VIIa in Jehovah's Witness patients undergoing liver transplantation.
Indisputably, liver transplantation is among the most technically challenging operations in current practice and is compounded by significant coagulopathy and portal hypertension. Recombinant human coagulation factor VIIa (rFVIIa) is a new product that was initially described to treat bleeding in hemophilia patients. We present in this paper 10 liver transplants in Jehovah's Witness patients using this novel product at University of Southern California-University Hospital. The subject population included nine males and one female with an average age of 50 years. Six patients underwent cadaveric and four live donor liver transplantation. Surgeries were conducted following our established protocol for transfusion-free liver transplantation, which includes preoperative blood augmentation, intraoperative blood salvage, acute normovolemic hemodilution, and postoperative blood conservation. Factor rFVIIa was used at a dose of 80 microg/kg intravenously just prior to the incision in all patients, and a second intraoperative dose was used in 3 patients. All living donor liver transplantation (LDLT) recipients did well and were discharged uneventfully with normal liver functions. Two of the six cadaveric recipients died. One patient died intraoperatively from acute primary graft nonfunction, and the other died 38 hours postoperatively from severe anemia. This report suggests factor rFVIIa might have a much broader application in surgery in the control of bleeding associated with coagulopathy.
Jabbour
Nicolas
N
Division of Hepatobiliary and Transplant Surgery, University of Southern California-University Hospital, Los Angeles, California 90033, USA.
Gagandeep
Singh
S
Peilin
Alice Cheng
AC
Boland
Brendan
B
Mateo
Rod
R
Genyk
Yuri
Y
Selby
Rick
R
Zeger
Gary
G
D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D001804:Blood Transfusion, Autologous / Q000379:methods; D001810:Blood Volume; D002102:Cadaver; D002423:Cause of Death; D003029:Coagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006438:Hemodilution / Q000379:methods; D006801:Humans; D033221:Jehovah's Witnesses; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012068:Religion and Medicine; D019896:alpha 1-Antitrypsin Deficiency / Q000601:surgery
D003029:Coagulants; D011994:Recombinant Proteins; D015942:Factor VIIa