title: Aminocaproic Acid (amicar) as an alternative to aprotinin (trasylol) in liver transplantation.
abstract: BACKGROUND
  This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period.
  
  
  METHODS
  Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent.
  
  
  RESULTS
  Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28%]), high-dose aprotinin (n = 308 [26%]), EACA (n = 216 [18%]), or no antifibrinolytic (n = 322 [28%]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA.
  
  
  CONCLUSIONS
  These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: rmangus@iupui.edu.
authors.forename: R S
authors.initials: RS
authors.lastname: Mangus
authors.affiliation: Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: S B
authors.initials: SB
authors.lastname: Kinsella
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: J A
authors.initials: JA
authors.lastname: Fridell
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: C A
authors.initials: CA
authors.lastname: Kubal
authors.affiliation: Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: P
authors.initials: P
authors.lastname: Lahsaei
authors.affiliation: Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: L O
authors.initials: LO
authors.lastname: Mark
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: A J
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015119:Aminocaproic Acid / Q000008:administration & dosage*; D007611:Aprotinin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007611:Aprotinin; D015119:Aminocaproic Acid