Bontempo, FA

Kang, YG

Knot, EAR

Lewis, JH

Porte, RJ

Starzl, TE

English

PubMed

D-Scholarship@Pitt

------------_._--.----- ---~-~ -- --------_._--Tissue-Type-Plasminogen-Activator-Associated Fibrinolysis in Orthotopic Liver Transplantation R.J. Porte, FA Bontempo, EAR. Knot, J.H. Lewis, Y.G. Kang, and T.E. Starzl ORTHOTOPIC liver transplantation is frequently asso-ciated with hemostatic disorders and a bleeding diath-esis.I.2 Accelerated fibrinolysis has been recognized as an important component of the hemostatic defectY The origin of this fibrinolytic activity, however, is still unclear. We investigated the role of tissue-type plasminogen activator (tPA). a potent activator of the fibrinolytic system, in the origin of increased fibrinolytic activity during orthotopic liver transplantation. MATERIALS AND METHODS Arterial blood samples were taken at regular intervals during 20 consecutive, first-time orthotopic liver transplantations in adults. Fibrinolysis was measured by euglobulin lysis time (ELT; normal > 120 minutes) and whole blood clot lysis time, as determined by thromboelastography (normal >150 minutes). tPA activity was measured in acidified plasma (pH 4.0-4.1) using Coaset tPA/PAI (Kabi Vitrum, Stockholm, Sweden) (normal: 0-1 IV/mL). RESULTS In all but one patient moderate to severe fibrinolysis, as measured by shortening of EL T or whole blood clot lysis time, was found in at least one blood sample during surgery. Intraoperative levels of tPA activity are shown in Fig 1. An intraoperative increase of tPA activity was found in 18 of the tPA-ael 50 [ lJ/mI 40 30 10 T o • Fig 1. Tissue-type plasminogen activator activity during liver transplantation (n - 20). Blood samples were taken after Induction of anesthesia, 30 minutes before the anhepatlc stage, 10 minutes into the anhepatlc stage, 5 minutes before reperfuslon, 5 minutes, 30 minutes, 90 minutes, and 180 minutes after reperfusion, and at the end of the procedure. 3542 20 patients. Comparison of the tPA activity levels and the corresponding values of the EL T showed that an increase of tPA activity to about \0 IU/mL resulted in a rapid short-ening of the EL T, while a further increase had no additional effect. A more linear relation was found between tPA activity and the whole blood clot lysis time. DISCUSSION It was demonstrated that orthotopic liver transplantation is associated with a high increase of plasma levels of tPA activity. A combination of increased release and reduced hepatic clearance may explain the initial increase during the anhepatic stage. This view is supported by the lack of fibrinolysis activation during auxiliary liver transplantation.) An "explosive" increase in tPA activity occurred immedi-ately after reperfusion. This is in agreement with the clinical findings of generalized oozing and increased blood loss during this period,2 and suggests a release of tPA from the donor liver. In a recent small study, increased plasma levels of tPA occurred primarily during the an hepatic stage of orthotopic liver transplantation.4 Since we observed an extreme increase in tPA activity only during a short period after reperfusion, this peak could have been missed if no blood samples were taken within 10 minutes after reperfu-sion. Although the systemic increase in tPA activity is transient, the clinical effect may extend over a considerably longer period, as tPA may bind to fibrin and become incorporated in newly formed hemostatic clots, resulting in early lysis and insufficient hemostatic function. REFERENCES I. Groth CG: in Starzl TE, Putman CW (eds): ExperH:nce in Hepatic Transplantation Philadelphia: WB Saunders, 1969, p 159 2. Kang YG, Martin DJ, Marquez J. et al: Anesth Analg 64:888, 1985 3. Porte RJ. Knot EAR, de Maat MPM, et al: Fibrinolysis 2 (suppl 3 ):67, 1988 4. Dzik WH, Arkin C F, Jenkins RL. et al: Blood 71 :1090, 1988 From the Department of Internal Medicine II. University Hospital Dijikzigt, Rotterdam. The Netherlands; Central Blood Bank. Pitts' burgh. PA; Departments of Anesthesiology and Surgery, Presby-terian-University Hospital. Pittsburgh, PA. Address reprint requests to Dr Porte. University Hospital Dijk· zig!, Rotterdam. The Netherlands. © 1989 by Appleton & Lange 0041-1345/89/$3.001 +0 Transplantation Proceedings. Vol 21, No 3 (June). 1989: p 3542 t 

Tissue-type-plasminogen-activator-associated fibrinolysis in orthotopic liver transplantation

Name not available

Tissue type plasminogen activator associated fibrinolysis in orthotopic liver transplantation

http://d-scholarship.pitt.edu/4399/1/31735062110543.pdf

Tissue-type-plasminogen-activator-associated fibrinolysis in orthotopic liver transplantation

Abstract

Similar works

Full text

Available Versions

D-Scholarship@Pitt

Name not available

Name not available