TY - JOUR
T1 - Reduced transfusion requirements by recombinant factor VIIa in orthotopic liver transplantation
AU - Hendriks, Herman G.D.
AU - Meijer, Karina
AU - De Wolf, Joost Th M.
AU - Klompmaker, Ids J.
AU - Porte, Robert J.
AU - De Kam, Pieter Jan
AU - Hagenaars, Ans J.M.
AU - Melsen, Tina
AU - Slooff, Maarten J.H.
AU - Van der Meer, Jan
PY - 2001/2/15
Y1 - 2001/2/15
N2 - Background. Large transfusion requirements, i.e., excessive blood loss, during orthotopic liver transplantation (OLT) are correlated witlh increased morbidity and mortality. Recombinant factor VIIa (rFVIIa) has been shown to improve hemostasis in a variety of conditions, but has never been studied in liver transplantation. Methods. We performed a single-center, open-label, pilot study in adult patients undergoing OLT for cirrhosis Child-Pugh B or C, to assess efficacy and safety of rFVIIa. rFVIIa (80 μg/kg) was administered at the start of the operation, to be repeated according to predefined criteria. Packed red blood cells (RBC), fresh-frozen plasma, and platelet concentrates were administered according to predefined criteria. Perioperative transfusion requirements in study patients were compared with matched controls. Results. Six patients were enrolled in the study. All received a single dose of rFVIIa. Transfusion requirements (given as median, with range in parentheses) were lower in the study group than in matched controls: 1.5 (0-5) vs. 7 (2-18) units of allogeneic RBC (P=0.006), 0 (0-2) vs. 3.5 (0-23) units of autologous RBC (P=0.043), total amount of RBC 3 (0-5) vs. 9 (4-40) units (P=0.002). Transfused fresh-frozen plasma was 1 (0-7) vs. 8 (2-35) units (P=0.011). Blood loss was 3.5 L (1.4=5.3) vs. 9.8 L (3.7=35.0) (P=0.004). One study patient developed a hepatic artery thrombosis at day 1 postoperatively. Conclusions. A single dose of 80 μg/kg rFVIIa signifcantly reduced transfusion requirements during OLT. Further study is needed to establish the optimally effective and safe dose of rFVIIa in orthotopic liver transplantation.
AB - Background. Large transfusion requirements, i.e., excessive blood loss, during orthotopic liver transplantation (OLT) are correlated witlh increased morbidity and mortality. Recombinant factor VIIa (rFVIIa) has been shown to improve hemostasis in a variety of conditions, but has never been studied in liver transplantation. Methods. We performed a single-center, open-label, pilot study in adult patients undergoing OLT for cirrhosis Child-Pugh B or C, to assess efficacy and safety of rFVIIa. rFVIIa (80 μg/kg) was administered at the start of the operation, to be repeated according to predefined criteria. Packed red blood cells (RBC), fresh-frozen plasma, and platelet concentrates were administered according to predefined criteria. Perioperative transfusion requirements in study patients were compared with matched controls. Results. Six patients were enrolled in the study. All received a single dose of rFVIIa. Transfusion requirements (given as median, with range in parentheses) were lower in the study group than in matched controls: 1.5 (0-5) vs. 7 (2-18) units of allogeneic RBC (P=0.006), 0 (0-2) vs. 3.5 (0-23) units of autologous RBC (P=0.043), total amount of RBC 3 (0-5) vs. 9 (4-40) units (P=0.002). Transfused fresh-frozen plasma was 1 (0-7) vs. 8 (2-35) units (P=0.011). Blood loss was 3.5 L (1.4=5.3) vs. 9.8 L (3.7=35.0) (P=0.004). One study patient developed a hepatic artery thrombosis at day 1 postoperatively. Conclusions. A single dose of 80 μg/kg rFVIIa signifcantly reduced transfusion requirements during OLT. Further study is needed to establish the optimally effective and safe dose of rFVIIa in orthotopic liver transplantation.
UR - http://www.scopus.com/inward/record.url?scp=0035865124&partnerID=8YFLogxK
U2 - 10.1097/00007890-200102150-00011
DO - 10.1097/00007890-200102150-00011
M3 - Article
C2 - 11233901
AN - SCOPUS:0035865124
SN - 0041-1337
VL - 71
SP - 402
EP - 405
JO - Transplantation
JF - Transplantation
IS - 3
ER -