title: Hemostatic status in liver transplantation: association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis.
abstract: The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis. There were 35 hemorrhagic complications (9%) and 21 thrombotic complications (5%). In logistic regression analyses, a higher Model for End-Stage Liver Disease score (P = 0.01) and a lower fibrinogen value (P < 0.001) were independently associated with hemorrhaging, whereas only a lower protein C value (P < 0.001) was independently associated with thrombosis. In a receiver operating characteristic analysis, a low preoperative protein C value (with the most accurate cutoff value being 25%) was a reliable predictor of thrombotic complications after liver transplantation (area under the curve = 0.921, P < 0.001, sensitivity = 0.9, specificity = 0.8). In conclusion, the decreases in both procoagulants and anticoagulants in liver transplant recipients may additively result in a delicate hemostatic balance and predispose patients to both hemorrhagic and thrombotic complications. A lower preoperative protein C value (<25%) was demonstrated to be a significant and reliable predictor of postoperative thrombotic complications in liver transplant recipients.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Akiko
authors.initials: A
authors.lastname: Nakazawa
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Nishioka
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D019540:Area Under Curve; D003029:Coagulants / Q000627:therapeutic use*; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006487:Hemostasis; D006490:Hemostatics; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011184:Postoperative Period; D057234:Preoperative Period; D011486:Protein C / Q000737:chemistry; D012372:ROC Curve; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003029:Coagulants; D006490:Hemostatics; D011486:Protein C