Use of activated protein C in liver transplantation patients with septic shock.
Recombinant human activated protein C (rhAPC) has been approved for use in patients with severe sepsis at high risk of death. Because of the high risk of bleeding, liver transplantation (LT) patients have been excluded from the randomized control trials that evaluated efficacy and safety of rhAPC and, thus, few data are available on the use of this drug in LT patients with severe sepsis. We describe our experience with 5 LT recipients treated for septic shock with the best conventional therapy and rhAPC. Before rhAPC therapy, all the patients showed septic shock, with > or =3 organ dysfunctions and thrombocytopenia with impairment of coagulation. rhAPC therapy started within 30 hours after septic shock onset in all the patients who recovered from sepsis-induced circulatory failure, improved organ dysfunction, and completed the 96 hours of rhAPC therapy. During rhAPC infusion, 4 patients received fresh frozen plasma and/or platelet concentrates because of thrombocytopenia and severe hemostasis dysfunction. No major bleeding occurred and only 1 patient presented with minor bleeding events.
Rinaldi
Laura
L
Department of Anaesthesiology and Intensive Care Unit, University of Modena and Reggio Emilia, University Hospital of Modena [corrected] Eli-Lilly Italia, Sesto Fiorentino, Italy.
Marietta
Marco
M
Mignini
Mariano Alejandro
MA
Donno
Lara
L
Busani
Stefano
S
Codeluppi
Mauro
M
Masetti
Michele
M
Girardis
Massimo
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012772:Shock, Septic / Q000628:therapy*; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome
D011486:Protein C; D011994:Recombinant Proteins