Korean J Transplant.  2022 Nov;36(Supple 1):S143. 10.4285/ATW2022.F-2616.

Comparison between continuous versus intermittent infusion of human antithrombin III concentrate in the immediate postoperative period after liver transplantation

• Kim BR
• Oh J
• Lim L
• Sohn 2 JY
• Choi Y
• Yi NJ
• Lee KW
• Suh KS
• Ryu HG

• KMID: 2535659
• DOI: http://doi.org/10.4285/ATW2022.F-2616

Abstract

Background
Antithrombin-III (AT-III) concentrates have been used in the immediate postoperative period after liver transplantation to prevent critical thrombosis. In the preceding study that retrospectively analyzed the pharmacokinetics of AT-III in liver recipients, plasma AT-III activity level was expected to be more stably maintained in the target range (80%–120%) with a continu-ous infusion regimen than with a conventional intermittent infusion regimen.
Methods
In this randomized controlled trial, 130 adult patients undergoing living-donor liver transplantation were randomly allocated into an intermittent infusion group (group I) or a continuous infusion group (group C). For group I, 500 international units (IU) of AT-III concentrate were administered after liver transplantation and repeated every 6 hours until postoperative 72 hours. For group C, 3,000 IU of AT-III was continuously infused for 71 hours after a loading dose of 2,000 IU over an hour. The plasma AT-III activity level was measured at 12, 24, 48, 72, and 84 hours from the first AT-III administration. The primary out-come was the target attainment rate at 72 hours. The plasma AT-III activity levels at other time points and associated complications were collected as secondary outcomes.
Results
A total of 107 patients were included in the analysis (54 patients for group I and 53 patients for group C). The target attainment rates at 72 hours post-dose were 30% and 62% in group I and group C, respectively (P=0.003). Compared to group I, patients in group C reached the target plasma AT-III activity level more rapidly (median time, 12 hours vs. 24 hours; P<0.001) and was more likely to remain in the target range until 84 hours.
Conclusions
The continuous infusion regimen was more adequate in maintaining the serum AT-III activity level within the normal range compared to the conventional intermittent infusion regimen.