THE PROPHYLACTIC EFFECT OF APROTININ ON INTRAOPERATIVE BLEEDING IN LIVER-TRANSPLANTATION - A RANDOMIZED CLINICAL-STUDY

Fibrinolysis has been recognized as an importan cause of intraoperativ e bleeding during orthotopic liver transplantation (OLT). Several inve stigators have used prophylactic administration of aprotinin in patien ts to inhibit fibrinolysis and to decrease transfusion requirements, m orbidity, and mortality. Nevertheless, the role of aprotinin in this s ituation is not yet clear. The goal of this study was to determine the effects of prophylactic administration of aprotinin on intraoperative bleeding and blood requirements, and on hemostatic changes during OLT . Eighty consecutive patients were included in a double-blind, prospec tive study and were randomized in two groups, In group A (n = 39), an initial dose of 2 x 10(6) kallikrein inactivator units (KIU) of aproti nin was administered in the induction of anesthesia followed by infusi on of 5 X 10(5) KIU/h until the end of the procedure. The control grou p (n = 41) received an identical volume of saline solution. The majori ty of the operations were performed with vena cava preservation (piggy -back technique) without venovenous bypass, During the anhepatic phase , a significant increase in levels of tissue plasminogen activator, th rombin-antithrombin complexes (TAT) and D-dimers (DD) was noted in bot h groups. A significant increment of TAT was observed in group A durin g reperfusion. The remaining hemostatic parameters were similar in bot h groups, Intraoperative requirements of packed red cells, fresh-froze n plasma (FFP), platelets, and cryoprecipitate were similar in the two groups. Our results suggest that prophylactic administration of aprot inin is not useful in reducing bleeding and blood product requirements during OLT.