Evaluation of Coagulation in Orthotopic Liver Transplantation with Thrombelastography_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiao ¹ , LUO Chaozhi ¹ , WANG Jian ¹ , WEN Tianfu ² , LU Shichun ² , LI Bo ² , YAN Lnan ²

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Orthotopic liver transplantation; Thrombelastography; Coagulation

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ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. Results
In cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.

Citation： WANG Xiao,LUO Chaozhi,WANG Jian,WEN Tianfu,LU Shichun,LI Bo,YAN Lnan. Evaluation of Coagulation in Orthotopic Liver Transplantation with Thrombelastography. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(3): 260-262. doi: Copy

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1. Kang Y.Coagulation and liver transplantation [J].Transplant Proc, 1993; 25（2）∶2001.
2. McNicol PL,Liu G,Harley ID, et al. Patterns of coagulopathy during liver transplantation:experience with the first 75 cases using thrombelastography [J]. Anaesth Intensive Care,1994; 22（6）∶659.
3. Kang YG, Martin DJ, Marquez J, et al. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation [J]. Anesth Analg, 1985; 64（9）∶888.
4. 刘克玄，黄文起，陈秉学，等. 原位肝移植术中肝素酶修正凝血弹性图的价值 [J]. 临床麻醉学杂志，2001； 17（12）∶8.
5. Bellani KG,Estrin JA,Ascher NL,et al.Reperfusion coagulopathy during human liver transplantation [J]. Transplant Proc,1987; 19（4 Suppl 3）∶71.
6. Harding SA,Mallett SV,Peachey TD,et al.Use of heparinase modified thrombelastography in liver transplantation [J]. Br J Anaesth,1997; 78（2）∶175.
7. Pivalizza EG,Abramson DC,King FS Jr.Thrombelastography with heparinase in orthotopic liver transplantation [J]. J Cardiothorac Vasc Anesth, 1998; 12（3）∶305.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation of Coagulation in Orthotopic Liver Transplantation with Thrombelastography

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