COAGULATION AND FIBRINOLYSIS IN PRIMARY BILIARY-CIRRHOSIS COMPARED WITH OTHER LIVER-DISEASE AND DURING ORTHOTOPIC LIVER-TRANSPLANTATION

Cirrhosis is associated with compromised hemostasis and coagulopathy d uring orthotopic Liver transplantation (OLT). It has been suggested th at hemostasis is better preserved during OLT in primary biliary cirrho sis (PBC) than other cirrhotic states. The aim of this study was to co mpare coagulation and fibrinolysis in 15 patients with PBC with 31 pat ients with other liver disease before and during OLT. Preoperatively, both groups had subnormal mean levels of prekallikrein, factor XIIa, a ntithrombin III (ATIII), plasminogen, and alpha(2)-antiplasmin. C1 est erase inhibitor and kallikrein inhibition in PBC was higher than the n ormal range (P < .01), but not in non-PBC. Non-PBC had lower median fi brinogen levels and shorter euglobulin clot lysis times (ECLT) (P < .0 5). Tissue plasminogen activator (tPA) antigen levels did not differ b etween groups but were elevated from the normal range, as were median thrombin-antithrombin complexes (TAT). Plasminogen activator inhibitor (PAI) activity was significantly higher in PBC (0.0041). Perioperativ ely in the PBC group during the early anhepatic phase of OLT, there wa s more thrombin generation, as evidenced by higher TAT levels (P = .04 55) and less hyperfibrinolysis with longer ECLTs. We hypothesize that there is a preserved capacity to generate thrombin and less fibrinolyt ic activation during the anhepatic phase of OLT, and we suggest that, in PBC, the use of antifibrinolytic agents may have an adverse effect.