Administration of a recombinant factor Vlla in patients undergoing liver transplantation for fulminant hepatic failure.
BACKGROUND
Fulminant hepatic failure (FHF) is associated with profound clotting disturbances leading to the risk of a major blood loss during orthotopic liver transplantation (OLT). Application of a recombinant factor VIIa (rVIIa) that promptly corrects clotting abnormalities remains controversial in the OLT setting. We conducted a retrospective analysis of the effect of rVIIa on the prothrombin time (PT) and other perioperative parameters in patients transplanted for FHF in our center.


METHODS
Nineteen consecutive patients (9 males/10 females) of overall mean age of 33 +/- 13 years underwent the procedure due to: Wilson's (n = 8), non-A-non-B hepatitis (n = 6) or Amanita phalloides toxicity (n = 5). All subjects received rVIIa at a mean dose of 54 +/- 16 microg/kg body weight at 10 minutes before the skin incision. The PT was measured at 15 minutes and 12 hours after injection. Data were analyzed with StatView program with P < .05 considered significant.


RESULTS
Rapid correction of PT was observed in all patients: the mean PT before injection was 37 +/- 14 versus 14 +/- 3 after 15 minutes (P < .0001). Twelve hours after the injection the PT was 19 +/- 5 (P < .0001 vs before injection and P < .0007 vs 15 minutes after injection). Two patients died at 1 and 4 days after OLT. Mean red blood cell requirement was 5 +/- 4 U and fresh frozen plasma was 11 +/- 5 U. The mean operative time was 527 +/- 126 minutes and intensive care unit stay 8 +/- 9 days. None of the patients developed thromboembolic complications.


CONCLUSIONS
Administration of rVIIa caused a rapid improvement in the PT shortly after injection. It was safe and not associated with any thromboembolic events in our series.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Marie Curie Hospital, ul. Arkonska 4, 71-455 Szczecin, Poland. jaroszki@interia.pl
K
K
Jarosz
M
M
Czupryńska
J
J
Andrzejewska
M P
MP
Wasilewicz
M
M
Post
J
J
Lubikowski
M
M
Wójcicki
P
P
Milkiewicz
D000328:Adult; D015942:Factor VIIa / Q000627:therapeutic use*; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D008875:Middle Aged; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
D011994:Recombinant Proteins; D015942:Factor VIIa