Protein C activity and postoperative metabolic liver function after liver transplantation.
BACKGROUND
Protein C is a natural thrombin antagonist produced by hepatocytes. Its levels are low in liver failure and predispose patients to increased risk for thrombosis. Little is known about the relationship between protein C activity and hepatic function after orthotopic liver transplantation (OLT).


METHODS
We measured protein C activity of 41 patients undergoing liver transplantation by the Staclot method (normal range, 70%-130%) preoperatively and then daily on postoperative days (POD) 0-5.


RESULTS
The mean protein C activity was low before OLT (34.3 ± 4.3%) and inversely correlated with the preoperative Model for End-Stage Liver Disease score (Spearman's r = -0.643; P < .0001). Mean activity increased significantly on POD 1 (58.9 ± 4.5%), and remained above preoperative levels through POD 5. Ten patients developed metabolic liver dysfunction defined by a serum total bilirubin >5 mg/dL on POD 7. These patients had significantly lower protein C activity from POD 3 (47.2 ± 9.6% vs 75.9 ± 5.8%; P = .01) to POD 5. Preoperative protein C activity correlated inversely with the severity of liver failure as indicated by preoperative MELD score.


CONCLUSIONS
Protein C activity recovered rapidly in patients with good allograft function but remained significantly lower in patients who had limited metabolic function as evidenced by increased total bilirubin levels.
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032-3784, USA. gw72@columbia.edu
G
G
Wagener
G
G
Diaz
J V
JV
Guarrera
M
M
Minhaz
J F
JF
Renz
R N
RN
Sladen
D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009518:New York; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011486:Protein C / Q000378:metabolism*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D011486:Protein C; D001663:Bilirubin