LIVER-TRANSPLANTATION WITHOUT THE USE OF FRESH-FROZEN PLASMA

In orthotopic liver transplantations (OLT), fresh frozen plasma (FFP) is classically used to normalize coagulation factor concentrations. In this study, 28 OLT were performed without the use of FFP. According t o their preoperative factor V (FV) levels, two groups of patients were defined: Group 1 (13 patients, FV >10% and <60%) and Group 2 (15 pati ents, FV >60%). Spontaneous evolution of coagulation factors, concentr ation, and bleeding were observed during OLT and up to 48 h after surg ery. Total intraoperative bleeding was similar in both groups (3460 +/ - 2700 mt and 3470 +/- 2110 mt in Groups 1 and 2, respectively). Level s of clotting factors were not different between groups after the anhe patic stage. The lowest values were noted after reperfusion, Thirty-si x hours after surgery, all levels of clotting factors in both groups w ere more than 50%, with FV level increasing the most rapidly. Hematocr it from the subhepatic drainage liquid was 1.8% and less than 1% at 24 and 48 h, respectively, after surgery. No reintervention for bleeding was necessary. These results suggest that, in OLT, correct hemostasis can be assumed without FFP use when hyperfibrinolysis, platelet count , fibrinogen rate, and hemodynamic status are controlled.