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liver, coagulation, transplantation

Mian Ahmad, Johann Mathew, Usama Iqbal, Rayhan Tariq
Massive blood loss has been a dreaded complication of liver transplantation, and the accompanying transfusion is associated with adverse outcomes in the form of decreased patient and graft survival. With advances in both surgical techniques and anesthetic management during transplantation, blood and blood products requirements reduced significantly. However, transfusion practices vary among different centers. The altered coagulation parameters in patients with liver cirrhosis results in a state of "rebalanced hemostasis" and patients are just as likely to clot as they are to bleed...
July 2018: Saudi Journal of Anaesthesia
Laura C Burlage, Sarah Bos, Jelle Adelmeijer, Takumi Sakai, Robert J Porte, Ton Lisman
BACKGROUND: Recombinant soluble human thrombomodulin (ART-123) is an anticoagulant and anti-inflammatory agent clinically used for treatment of disseminated intravascular coagulation. Preclinical studies have shown that ART-123 reduces hepatic ischemia/reperfusion. Although ART-123 may therefore have clinical benefit in orthotopic liver transplantation the substantial alterations in the hemostatic system may complicate its use in this setting. OBJECTIVE: Here we studied the in vitro effect of ART-123 on coagulation of patients with end-stage liver disease undergoing liver transplantation...
August 1, 2018: Liver Transplantation
Lesley De Pietri, Roberto Montalti, Daniele Nicolini, Roberto Ivan Troisi, Federico Moccheggiani, Marco Vivarelli
Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation (LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications (intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients...
July 21, 2018: World Journal of Gastroenterology: WJG
Marceli K Łukaszewski, Paweł Chudoba, Agnieszka Lepiesza, Marcin Rychter, Piotr Szyber
BACKGROUND: Coagulation system disorders in liver transplantation (ltx) patients are considered a serious issue. Liver cirrhosis leads to decreased synthesis of clotting factors and decreased elimination of waste products, including coagulation proteins. Platelet sequestration and dysfunction in an enlarged spleen additionally worsen these conditions. The resulting state, the most common pathology of the coagulation system, involves the reduction of clotting potential and hyperfibrinolysis...
July 18, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Mario Concha P, Verónica Mertz K, Gabriel Muñoz Castillo, Alejandro Delfino Y, Luis Cortínez F, Rodrigo Montaña R, Juan Cristóbal Pedemonte T, Ricardo Fuentes H
BACKGROUND: Compared to standard coagulation essays (SCE), such as international normalized ratio (INR), prothrombin activated partial thromboplastin time (aPTT), or platelet count, thromboelastograhy (TEG) offers precise and real-time information about hemostasis. TEG tests both platelet function and coagulation by assaying several parameters of clot formation dynamically in whole blood. AIM: To evaluate hemostasis in cirrhotic patients undergoing liver transplantation and determine the positive and negative predictive values of SCE for alterations of TEG...
March 2018: Revista Médica de Chile
I-Ting Peng, Ming-Ting Chung, Ching-Chung Lin
Postpartum hemorrhage remains a major threat to maternal health. Intervention after critical blood loss or development of disseminated intravascular coagulation may lead to disastrous organ failure and poor outcomes. A 30-year-old woman was transferred to our emergency department due to massive postpartum hemorrhage. Shock and disseminated intravascular coagulation ensued, and the patient's condition quickly deteriorated. We performed an emergency hysterectomy, but blood loss had been massive. Moreover, there was another episode of internal bleeding that led to further blood loss...
2018: Case Reports in Obstetrics and Gynecology
Luis J Serrano, Ana Cañete, Tamara Garcia-Leal, Laura Tomás-Gallardo, Ana I Flores, Paz de la Torre, Antonio Liras, María José Sánchez
The development of new strategies based on cell therapy approaches to correct haemophilia A (HA) requires further insights into new cell populations capable of producing coagulation factor VIII (FVIII) and presenting stable engraftment potential. The major producers of FVIII in the adult are liver sinusoidal endothelial cells (LSECs) and in a lesser degree bone marrow-derived cells, both of which have been shown to ameliorate the bleeding phenotype in adult HA mice after transplantation. We have previously shown that cells from the foetal liver (FL) and the aorta-gonads-mesonephros (AGM) haematopoietic locations possess higher LSEC engraftment potential in newborn mice compared with adult-derived LSECs, constituting likely therapeutic targets for the treatment of HA in neonates...
August 2018: Thrombosis and Haemostasis
José Carlos Rodrigues Nascimento, David Silveira Marinho, Rodrigo Dornfeld Escalante, Bodiyabaduge Emmanuel M Daya Pereira Junior, Cristiane Gurgel Lopes, Rogean Rodrigues Nunes
INTRODUCTION: Advanced hepatic disease may - in addition to the widely recognized hemorrhagic complications - occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (Rotem® ). CASE REPORT: A 56 year-old male patient diagnosed with alcohol cirrhosis using warfarin ( ) for partial portal vein thrombosis with the International Normalized Ratio (INR) of 2...
June 30, 2018: Revista Brasileira de Anestesiologia
Tomasz Mikuła, Joanna Kozłowska, Wojciech Stańczak, Mariusz Sapuła, Aleksandra Różyk, Alicja Wiercińska-Drapało
Background: Coagulation disorders in patients with liver cirrhosis are a common clinical problem. Cirrhosis should be considered a state of impaired blood clotting or an imbalance of the whole coagulation system. Cirrhosis-induced coagulopathy encompasses disturbances in both the procoagulant and anticoagulant systems. This mechanism may promote the development of thrombosis with portal vein thrombosis (PVT), which is considered an obstacle to orthotopic liver transplantation (OLT). We assessed serum ADAMTS-13 levels in patients with decompensated liver cirrhosis, with and without PVT...
2018: Gastroenterology Research and Practice
Cristina Stasi, Caterina Silvestri, Roberto Berni, Maurizia Rossana Brunetto, Anna Linda Zignego, Cristina Orsini, Stefano Milani, Liana Ricciardi, Andrea De Luca, Pierluigi Blanc, Cesira Nencioni, Donatella Aquilini, Alessandro Bartoloni, Giampaolo Bresci, Santino Marchi, Franco Filipponi, Piero Colombatto, Paolo Forte, Andrea Galli, Sauro Luchi, Silvia Chigiotti, Alessandro Nerli, Giampaolo Corti, Rodolfo Sacco, Paola Carrai, Angelo Ricchiuti, Massimo Giusti, Paolo Almi, Andrea Cozzi, Silvia Carloppi, Giacomo Laffi, Fabio Voller, Francesco Cipriani
BACKGROUND: Recent introduction of direct antiviral agents (DAAs) has completely changed the scenario regarding hepatitis C virus (HCV) treatment. Certain countries' economic health programs prioritize DAAs according to specific clinical features of HCV-infected patients. The aim of this study was to define epidemiological, demographic and clinical characteristics of HCV-infected patients in the Tuscany region of central Italy. METHODS: We enrolled HCV patients with chronic viral hepatitis who were referred to the outpatient services of 16 hospitals in Tuscany from 1 January 2015 to 31 December 2015...
June 26, 2018: Current Medical Research and Opinion
Fuat H Saner, Dmitri Bezinover
No abstract text is available yet for this article.
May 15, 2018: Minerva Anestesiologica
D Arni, B E Wildhaber, V McLin, P C Rimensberger, M Ansari, P Fontana, O Karam
BACKGROUND AND OBJECTIVES: Thrombotic complications affect 3-10% of patients after liver transplantation (LT), leading to potentially life-threatening complications. In the days following LT, antithrombin (AT) is decreased longer than pro-coagulant factors, thus favouring a pro-thrombotic profile. Plasma transfusions are given empirically in some centres to correct AT levels following LT. We assessed the effect of plasma transfusion on AT levels after paediatric LT. MATERIALS AND METHODS: Prospective single-centre observational study in 20 consecutive paediatric LT recipients over a 24-month period...
May 15, 2018: Vox Sanguinis
Olga Meltem Akay
Hemostasis is a complex dynamic process involving bleeding and thrombosis as two end-points. Conventional coagulation tests which are measured in plasma examine only isolated portions of the coagulation cascade, thereby giving no information on important interactions essential to the clinical evaluation of hemostatic function. Thromboelastography (TEG), originally described in 1948 has improved over the decades and become a valuable tool of coagulation testing because of the limitations of standard coagulation tests...
September 2018: Clinical and Applied Thrombosis/hemostasis
Arabesque Parker, Constantine J Karvellas
Patients with cirrhosis undergoing liver transplantation have unique challenges with regard to the prevention and management of thrombosis and hemorrhage. Patients with cirrhosis have an unstable balance of the coagulation system due to defects in both prothrombotic and antithrombotic components. These changes make laboratory monitoring challenging, prophylaxis against bleeding and thrombosis controversial, and therapy for the same uncertain. When cirrhotic patients undergo liver transplantation they frequently have significant transfusion requirements...
May 7, 2018: Transplantation
Tsukasa Ohmori, Hiroaki Mizukami, Yuko Katakai, Sho Kawai, Hitoyasu Nakamura, Makoto Inoue, Tsugumine Shu, Hideharu Sugimoto, Yoichi Sakata
Joint bleeding and resultant arthropathy are major determinants of quality of life in haemophilia patients. We previously developed a mesenchymal stromal cell (MSC)-based treatment approach for haemophilic arthropathy in a mouse model of haemophilia A. Here, we evaluated the long-term safety of intra-articular injection of lentivirally transduced autologous MSCs in non-human primates. Autologous bone-marrow-derived MSCs transduced with a lentiviral vector expressing coagulation factor VIII (FVIII) were injected into the left knee joint of cynomolgus monkeys...
May 8, 2018: International Journal of Hematology
Hye-Mee Kwon, In-Gu Jun, JungBok Lee, Young-Jin Moon, Kyeo-Woon Jung, Hye-Won Jeong, Yong-Seok Park, Jun-Gol Song, Gyu-Sam Hwang
Desensitisation with therapeutic plasma exchange (TPE) is essential for ABO-incompatible (ABO-I) liver transplants (LTs). However, excessive citrate load and coagulation disturbances after TPE have been poorly studied, in particular in cirrhotic patients with hypocapnic alkalosis, metabolic compensation and electrolyte imbalances. We retrospectively evaluated 1123 consecutive LT recipients (923 ABO-compatible [ABO-C], 200 ABO-I) from November 2008 to May 2015. TPE was generally performed a day before LT and blood sampling was performed before anaesthesia induction...
April 27, 2018: Scientific Reports
Heba A Moharem, Fawzia Aboul Fetouh, Hamed M Darwish, Doaa Ghaith, Mohamed Elayashy, Amr Hussein, Riham Elsayed, Mohammad M Khalil, Amr Abdelaal, Mahmoud ElMeteini, Ahmed Mukhtar
BACKGROUND: Bacterial translocation (BT) has been proposed as a trigger for stimulation of the immune system with consequent hemodynamic alteration in patients with liver cirrhosis. However, no information is available regarding its hemodynamic and coagulation consequences during liver transplantation. METHODS: We screened 30 consecutive adult patients undergoing living-donor liver transplant for the presence of BT. Bacterial DNA, Anti factor Xa (aFXa), thromboelastometry, tumor necrosis factor-α TNF-α, and interleukin-17 (IL-17) values were measured in sera before induction of anesthesia...
April 25, 2018: BMC Anesthesiology
Nadia Waheed, Huma Arshad Cheema, Hassan Suleman, Iqra Mushtaq, Zafar Fayyaz, Nadeem Anjum
OBJECTIVE: To differentiate between clinical and demographic spectrum, and outcome in hepatovenocaval syndrome (HVCS) and Budd-Chiari syndrome (BCS). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children Hospital, Lahore, from January 2014 to January 2017. METHODOLOGY: All children less than 18 years of age, presenting with ascites and visible veins over abdomen, flanks and back were enrolled in the study...
May 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Eun-Hee Kim, Justin S Ko, Mi-Sook Gwak, Suk-Koo Lee, Gaab-Soo Kim
: We evaluated the incidence and clinical significance of hyperfibrinolysis during living donor liver transplantation (LDLT) using viscoelastic coagulation tests. We retrospectively reviewed adult LDLT recipients from February 2010 to February 2015. Hyperfibrinolysis was defined when clot lysis index [LY60 = (MA - A60)/MA × 100, %] was less than 85, where A60 is the clot amplitude at 60 min after maximum amplitude (MA) occurred. Viscoelastic coagulation tests were performed six times (T1: immediately after anesthetic induction, T2: end of preanhepatic phase, T3: 1 h after anhepatic phase, T4: 5 min after reperfusion, T5: 1 h after reperfusion, and T6: 3 h after reperfusion)...
April 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Liaoran Wang, David K C Cooper, Lars Burdorf, Yi Wang, Hayato Iwase
There has recently been considerable progress in the results of pig organ transplantation in nonhuman primates, largely associated with the availability of (i) pigs genetically engineered to overcome coagulation dysregulation, and (ii) novel immunosuppressive agents. The barriers of thrombotic microangiopathy and/or consumptive coagulation were believed to be associated with (i) activation of the graft vascular endothelial cells by a low level of antipig antibody binding and/or complement deposition and/or innate immune cell activity, and (ii) molecular incompatibilities between the nonhuman primate and pig coagulation-anticoagulation systems...
July 2018: Transplantation
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