Coagulation During and After Orthotopic Transplantation of the Human Liver

In earlier reports from this institution^1,2 changes in hemostasis were described in five patients treated with orthotopic homotransplantation of the liver. There was an intraoperative bleeding diathesis at the same time as fibrinolysis and hypofibrinogenemia developed. In four of the cases, the hemorrhage was eventually controlled after the administration of epsilon aminocaproic acid (EACA), fibrinogen, and fresh blood. Subsequently, three of the four survivors formed thrombi at or near femoral venotomy sites which had been used for the insertion of external bypass catheters; in all three, the eventual result was multiple pulmonary embolization.

Appreciation of the seriousness of these problems prompted a number of investigations to be performed in dogs and pigs^2-5 to more fully characterize the clotting abnormalities of liver transplantation and to learn if a succeeding period of hypercoagulability was an inherent part of the picture. It has been established from these studies that hepatic homotransplantation