title: Aprotinin versus tranexamic acid during liver transplantation: impact on blood product requirements and survival.
abstract: BACKGROUND
  Historically, orthotopic liver transplantation (OLT) has been associated with major blood loss and the need for blood product transfusions. Activation of the fibrinolytic system can contribute significantly to bleeding. Prophylactic administration of antifibrinolytic agents was found to reduce blood loss.
  
  
  METHODS
  The efficacy of two antifibrinolytic compounds--aprotinin (AP) and tranexamic acid (TA)--was compared in OLT. Four hundred consecutive OLTs were studied: 300 patients received AP and 100 received TA. Multivariate logistic regression analysis was used to identify independent predictors of intraoperative transfusion requirement and 1-year patient mortality.
  
  
  RESULTS
  There was no intergroup difference in intraoperative blood loss (1082±1056 vs. 1007±790 mL), red blood cell transfusion per patient (0.5±1.4 vs. 0.5±1.0), final hemoglobin (Hb) concentration (93±20 g/L vs. 95±22 g/L), the percentage of OLT cases requiring no blood product administration (80% vs. 82%), and 1-year survival (85.1% vs. 87.4%). Serum creatinine concentrations were also the same (116±55 vs. 119±36 μmol/L) 1 year after surgery. Two variables, starting Hb and phlebotomy, correlated with the two primary outcome measures (transfusion and 1-year survival).
  
  
  CONCLUSIONS
  In our experience, administration of AP was not superior to TA with regards to blood loss and blood product transfusion requirement during OLT. In addition, we found no difference between the groups in the 1-year survival rate and renal function. Furthermore, we suggest that starting Hb concentration should be considered when prioritizing patients on the waiting list and planning perioperative care for OLT recipients.
authors: Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Hôpital St-Luc, Montreal, QC, Canada. luc.massicotte@umontreal.ca
authors: Luc
authors: L
authors: Massicotte
authors: André Y
authors: AY
authors: Denault
authors: Danielle
authors: D
authors: Beaulieu
authors: Lynda
authors: L
authors: Thibeault
authors: Zoltan
authors: Z
authors: Hevesi
authors: André
authors: A
authors: Roy