title: The use of TachoSil in children undergoing liver resection with or without segmental liver transplantation.
abstract: BACKGROUND
  Local haemostatic agents are used for the control of surgical haemorrhage when standard techniques are inadequate, but there are few studies of these products in children.
  
  
  METHODS
  This was a prospective, open-label study in which children (aged 4 weeks to 6 years) undergoing liver resection with or without segmental liver transplantation were treated with TachoSil, a collagen patch coated with a dry layer of human fibrinogen and human thrombin, if minor (i. e., oozing) or moderate bleeding was present after primary haemostatic treatment. Time to haemostasis after TachoSil application was the primary endpoint. Safety was assessed by adverse events (AEs), including post-operative infections, symptoms of graft rejection and re-operations.
  
  
  RESULTS
  Enrolment was stopped early after 16 children had entered the study. 13 children underwent whole liver resection and transplantation and 3 patients underwent segmental resection. Satisfactory haemostasis was achieved in 13 children (81.3%; 95% CI: 61.8-100%) at 3 min and in 1 child at 8 min. Occurrence of AEs was as expected, with most being known complications of the underlying disease, surgical procedure, or use of immunosuppressive medication. No AEs were considered to be related to the use of TachoSil.
  
  
  CONCLUSIONS
  The use of TachoSil for haemostasis after primary haemostatic treatment appears to be safe and effective in children undergoing liver resection.
authors.affiliation: Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom. darius.mirza@uhb.nhs.uk
authors.forename: D
authors.initials: D
authors.lastname: Mirza
authors.forename: A J W
authors.initials: AJ
authors.lastname: Millar
authors.forename: K
authors.initials: K
authors.lastname: Sharif
authors.forename: H
authors.initials: H
authors.lastname: Vilca-Melendez
authors.forename: M
authors.initials: M
authors.lastname: Rela
authors.forename: N
authors.initials: N
authors.lastname: Heaton
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005340:Fibrinogen / Q000494:pharmacology*; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D011446:Prospective Studies; D015503:Surgical Sponges; D013917:Thrombin / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin