PLASMA THROMBOMODULIN IN ORTHOTOPIC LIVER-TRANSPLANTATION

Plasma thrombomodulin (TM), a specific marker of vascular endothelial injury was measured pre-, per-, and postoperatively in 16 consecutive patients undergoing orthotopic liver transplantation (OLT). The TM lev el, which was already elevated preoperatively, remained unchanged duri ng OLT, except for an acute and transitory spike at the time of graft reperfusion. This TM peak is probably attributable to an acute release from the patient's endothelium because the TM level in the last salin e rinse of the graft before implantation was low. This TM spike was no t correlated with the progressive tissue-type plasminogen activator (t -PA) increase, plasminogen activator inhibitor 1 (PAI-1), or von Wille brand factor (vWF) values. The absence of accumulation of TM in plasma , unlike that of BPA, suggests that the liver does not play a major ro le in TM clearance in humans. At the end of surgery, individual TM val ues returned to preoperative levels and remained unchanged during the 7 days following surgery. This observation suggests that the high (or very high) TM levels measured in these patients might be due to an ind irect rather than a direct effect of liver dysfunction on the vascular endothelium which remained damaged during the postoperative period. T he possibility that TM might be a predictive marker for thrombotic OLT complications remains to be investigated in a postoperative follow-up study.