The Comparison of Coagulation Status in the Cadaveric Donor and Living-Related Liver Transplantation

Shin, Byung Seop; Ha, Im Hyoung; Kim, Gaab Soo; Gwak, Mi Sook; Chung, Ik Soo

Abstract

BACKGROUND: Orthotopic liver transplantation is widely regarded as the only effective treatment for many acute or chronic end-stage liver diseases. However, the shortage of cadaveric organs is one of the most crucial limitations to the liver transplantation. Recently, in our hospital, living-related liver transplantation (LR LT) cases have remarkably increased during the last two years. Because there are differences in the surgical procedure and graft volume between the cadaveric donor liver transplantation (Cd LT) and LRLT, the intraoperative coagulation status may be different, too. With the knowledge of coagulation status, the anesthetic mangement of liver transplantation will be improved.
METHODS
A retrospective evaluation was performed on 36 patients, who underwent an orthotopic liver transplantation between October 1999 and April 2001. Seventeen patients received a Cd LT and 19 patients underwent a LRLT. We compared the two groups in the aspects of coagulation related parameters; 1) ischemic time, 2) venovenous bypass (VVB) flow, 3) the percentages of occurrence of postreperfusion syndrome (PRS), 4) the ratio of activated clotting time (ACT) exceeding 200 seconds after reperfusion, 5) the ratio of hyperfibrinolysis, LY60 > 20%, on a thromboelastograph (TEG) after reperfusion, and 6) the amounts of transfusion and fluid administration before and after reperfusion.
RESULTS
The ischemic time was shorter in the LR LT group than the Cd LT group (115.4 +/- 25.4 min versus 409.2 +/- 115.6 min). The VVB flow was greater in the Cd LT group than the LR LT group. The ratio of occurrence of PRS was also lower in the LR LT group (11%) than the Cd LT group (53%). The percentage of ACT exceeding 200 seconds after reperfusion was only 11% in the LR LT group, but 59% in the Cd LT group. The percentages of LY 60 > 20% on the TEG after reperfusion were not statistically different in each group, but the percentage of tranexamic acid administration due to persistent, severe hyperfibrinolysis was higher in the Cd LT group than the LR LT group. The amounts of transfusion and fluid administration were significantly smaller in the LR LT group compared to those in the Cd LT group.
CONCLUSIONS
We found that there were many differences in the coagulation status between the Cd LT and the LR LT groups. Therefore, anesthesiologists should consider these differences and manage each case of liver transplantation properly.