Benefits of recombinant activated factor VII in complicated liver transplantation.
BACKGROUND
Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordiskA/S, Bagsvaerd, Denmark) has shown benefits in hemophilic patients and recently in transplant recipients. This study presents our experiences with rFVIIa in complicated liver transplant recipients.


METHODS
From May 2001 to August 2004, rFVIIa was administered to 7 patients undergoing liver transplantation. All treatments were made on emergency bases, except for 1 case with hemophilia A, who received prophylactic treatment. The drug was delivered when severe bleeding with coagulopathy persisted despite the usual treatment with blood products. The drug doses were 60-90 mug/kg; the results were evaluated clinically and analytically.


RESULTS
Seven patients undergoing liver transplantation were treated with FVIIa. Mean prothrombin times before and after treatment were 17.5 and 10.9 seconds, respectively, with a mean reduction of 7.2 seconds (P = .03). Mean thromboplastin times before and after treatment were 38.1 and 29.4 seconds, respectively, with a mean reduction of 8.7 seconds (P = .034). The average dose was 83.6 mug/kg, leading to decreased consumption of blood products (P < .01). In all cases, rFVIIa allowed sufficient hemostasis to carry on definitive treatment. There was no mortality in this series.


CONCLUSIONS
These results provide new evidence on the potential benefits of rFVIIa in liver transplantation, especially for rescue therapy in cases of severe bleeding.
Gala
B
B
Transplant Unit, Juan Canalejo University Hospital, La Coruña, Spain. gala32486@yahoo.com
Quintela
J
J
Aguirrezabalaga
J
J
Fernández
C
C
Fraguela
J
J
Suárez
F
F
Gómez
M
M
D015942:Factor VIIa / Q000627:therapeutic use*; D006467:Hemophilia A / Q000601:surgery*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D016031:Liver Transplantation; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000627:therapeutic use; D013926:Thrombopoietin / Q000032:analysis
D011994:Recombinant Proteins; D013926:Thrombopoietin; D015942:Factor VIIa