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.
Jarosz
K
K
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Marie Curie Hospital, ul. Arkonska 4, 71-455 Szczecin, Poland. jaroszki@interia.pl
Czupryńska
M
M
Andrzejewska
J
J
Wasilewicz
M P
MP
Post
M
M
Lubikowski
J
J
Wójcicki
M
M
Milkiewicz
P
P
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