Different aprotinin applications influencing hemostatic chances in orthotopic liver transplantation

The effect of different aprotinin applications on hemmtatic changes
and blood product requirements in orthotopic liver transplantation
was investigated in a prospective, open, and randomized study. From
November 1989 to June 1990, 13 patients received aprotinin as a
bolus of 0.5 Mill, kallikrein inac-tivator units (KIU) on three
occasions in the course of an OLT, whereas 10 other patients were
treated with continuous aprotinin infusion of 0.1-0.4 Mill. KIU/hr.
Before and after reperfusion of the graft liver, signs of
hyperfibrinolysis, measured by thrombelastography, were
significantly lower in the infusion group. Tissue-type plasminogen
activator (t-PA) activity increased during the anhepatic phase but
to a significantly lesser extent in the infusion group. Blood
product requirements during OLT were tendentiously higher in the
bolus group but not significantly so. However, the use of packed
red blood cells was significantly lower in the postoperative
period, whereas there was no significant difference in fresh frozen
plasma requirements between the two groups. All 23 patients have
survived, and only one woman of each group required
retransplantation due to severe host-versus-graft reactions.
Furthermore, we investigated the perfusate of the graft liver in
both groups and detected signs of a decreased t-PA release in the
infusion group. Our results demonstrate an advantage of aprotinin
given as continuous infusion over bolus application in OLT.