title: Abnormal hemostatic function one year after orthotopic liver transplantation can be fully attributed to endothelial cell activation.
abstract: BACKGROUND
  The long-term risk of thrombotic and vascular complications is elevated in liver transplant recipients compared to the general population. Patients with cirrhosis are in a hypercoagulable status during and directly after orthotopic liver transplantation, but it is unclear whether this hypercoagulability persists over time.
  
  
  OBJECTIVE
  We aimed to investigate the hemostatic status of liver transplant recipients one year after transplantation.
  
  
  METHODS
  We prospectively collected blood samples of 15 patients with a functioning graft one year after orthotopic liver transplantation and compared the hemostatic status of these patients with that of 30 healthy individuals.
  
  
  RESULTS
  Patients one year after liver transplantation had significantly elevated plasma levels of von Willebrand factor (VWF). Thrombin generation, as assessed by the endogenous thrombin potential, was decreased in patients, which was associated with increased plasma levels of the natural anticoagulants antithrombin and tissue factor pathway inhibitor.  Plasma fibrinolytic potential was significantly decreased in patients and correlated inversely with levels of plasminogen activator inhibitor-1.
  
  
  CONCLUSIONS
  One year after liver transplantation, liver graft recipients have a dysregulated hemostatic system characterised by elevation of plasma levels of endothelial-derived proteins. Increased levels of von Willebrand factor and decreased fibrinolytic potential may (in part) be responsible for the increased risk for vascular disease seen in liver transplant recipients.
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands ; Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Freeha
authors.initials: F
authors.lastname: Arshad
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Adelmeijer
authors.affiliation: Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Blokzijl
authors.affiliation: Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van den Berg
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Porte
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands ; Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman