Abstract
Purpose
During liver transplantation, excessive blood losses are correlated with increased morbidity and mortality. Blood losses are particularly high in the case of urgent liver transplantation for fulminant hepatic failure (FHF). Recombinant activated factor VII (rFVIIa) has shown promise in treating the coagulopathy of liver disease. We review our experience with the use of rFVIIa in treating the coagulopathy of FHF during urgent liver transplantation.
Clinical features
We report four patients with FHF who met King’s College criteria for liver transplantation and in whom rFVIIa was used after conventional means for treating the associated coagulopathy had failed. In all patients, the coagulation defect was corrected by rFVIIa. However, thrombotic complications occurred in two patients (myocardial ischemia and portal vein thrombosis) and the implication of rFVIIa cannot be excluded.
Conclusion
We conclude that rFVIIa is effective in the correction of the coagulopathy associated with FHF However, thrombotic events are of concern and therefore, further studies are warranted to define the safety of rFVIIa in that setting.
Résumé
Objectif
Pendant la transplantation hépatique, d’importantes pertes sanguines entraînent une hausse de la morbidité et de la mortalité. Ces pertes sont particulièrement élevées lors d’une transplantation d’urgence pour Insuffisance hépatique fulminante (IHF). Le facteur VII recombiné activé (rFVIIa) s’est montré prometteur contre la coagulopathie de la lésion hépatique. Nous passons en revue notre expérience de l’usage du rFVIIa pour traiter la coagulopathie de l’lHF pendant la transplantation hépatique d’urgence.
Éléments cliniques
Nous présentons quatre patients atteints d’IHF qui répondaient aux critères du King’s College pour la transplantation hépatique et chez qui le rFVIIa a été utilisé après l’échec du traitement traditionnel de la coagulopathie associée. Le rFVIIa a corrigé le défaut de coagulation chez tous les patients. Cependant, deux patients ont subi des complications thrombotiques (ischémie myocardique et thrombose de la veine porte) pour lesquelles l’implication du rFVIIa ne peut être exclue.
Conclusion
Le rFVIIa est efficace pour corriger la coagulopathie associée à l’IHF Néanmoins, les événements thrombotiques sont préoccupants et appellent à la réalisation d’autres études pour définir l’innocuité du rFVIIa dans ce contexte.
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Pavese, P., Bonadona, A., Beaubien, J. et al. FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: A report of four cases. Can J Anesth 52, 26–29 (2005). https://doi.org/10.1007/BF03018576
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DOI: https://doi.org/10.1007/BF03018576