title: Low incidence of hyperfibrinolysis and thromboembolism in 195 primary liver transplantations transfused with solvent/detergent-treated plasma.
abstract: BACKGROUND
  Liver transplantation regularly requires transfusion of red blood cells (RBCs), plasma, and platelets. Compared to fresh frozen plasma (FFP) from single blood donors, solvent/detergent-treated plasma (SD-plasma) pooled from several hundred blood donors has advantages with respect to pathogen reduction, standardized content of plasma proteins, and significantly reduced risk of transfusion related lung injury and allergic/immunologic adverse reactions. However, SD-plasma has been suspected to increase the incidence of hyperfibrinolysis and thromboembolic events.
  
  
  METHODS
  We investigated the transfusion practices, hyperfibrinolysis parameters, and thrombosis outcomes in 195 consecutive adult primary liver transplants in our center using SD-plasma (Octaplas) as the exclusive source of plasma.
  
  
  RESULTS
  Perioperatively, median (interquartile range) 4 (1 to 9) RBC-units, 10 (4 to 18) plasma-bags, and 0 (0 to 2) platelet-units were transfused. Hyperfibrinolysis defined as LY30 ≤ 7.5% was detected in 12/138 thrombelastography-monitored patients (9%). These patients received significantly more RBCs, plasma, and platelets than did patients without hyperfibrinolysis. Thrombotic graft complications were observed in three patients (2%). Pulmonary embolism was not observed in any patient.
  
  
  CONCLUSIONS
  SD-plasma is a safe plasma product for liver transplant recipients, and the incidences of hyperfibrinolysis and thromboembolic events are not significantly different from those seen in centers using FFP.
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway hakon.haugaa@medisin.uio.no.
authors.forename: Håkon
authors.initials: H
authors.lastname: Haugaa
authors.affiliation: Dept. of Immunology, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway.
authors.forename: Eli
authors.initials: E
authors.lastname: Taraldsrud
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Nyrerød
authors.affiliation: Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway.
authors.forename: Tor Inge
authors.initials: TI
authors.lastname: Tønnessen
authors.affiliation: Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway.
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.affiliation: Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Dept. of Immunology, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway.
authors.forename: Bjarte G
authors.initials: BG
authors.lastname: Solheim
mesh_terms: D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion / Q000379:methods*; D003902:Detergents; D005342:Fibrinolysis; D006474:Hemorrhagic Disorders / Q000453:epidemiology*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D009664:Norway; D010949:Plasma; D011183:Postoperative Complications / Q000453:epidemiology*; D012997:Solvents; D013916:Thrombelastography; D013923:Thromboembolism / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D003902:Detergents; D012997:Solvents
keywords: Hyperfibrinolysis; Liver transplantation; Solvent/detergent-treated plasma; Thromboembolism