EVIDENCE THAT INTRAOPERATIVE PROSTAGLANDIN-E1 INFUSION REDUCES IMPAIRED PLATELET-AGGREGATION AFTER REPERFUSION IN ORTHOTOPIC LIVER-TRANSPLANTATION

Recent investigations measuring platelet aggregation during 10 orthoto pic liver transplantations showed a significant decrease in platelet a ggregation immediately after reperfusion and in the perfusate. As pros taglandin E, has been shown to exhibit a beneficial effect in the trea tment of ischemic injury of the liver, we investigated in a prospectiv e, randomized, and open study the effect of PGE, infusion during OLT o n platelet function. Ten patients were randomized to receive a continu ous PGE1 infusion (PG group) and another ten patients served as contro ls. Platelet function was determined ex vivo by measuring the adenosin e diphosphate-, collagen-, and ristocetin-induced aggregation in plate let-rich plasma. A significantly higher platelet aggregability was mea sured in the PG group throughout the whole operation for ADP (I and 2 mumol/L) and collagen (0.5 mug/ml). The same was true for collagen (I mug/ml) and ristocetin (1.2 mg/ml) after reperfusion. Not only the pos treperfusional decrease in platelet aggregation but also the decline i n platelet count that occurred in the control group could be prevented greatly by PGE1 infusion. In the perfusate, released from the liver g raft vein by flushing with arterial blood, a significantly lower plate let aggregability was seen in comparison with the systemic circulation before reperfusion in the control group, a difference that was not fo und when PGE1 infusion was given intraoperatively. However, blood prod uct requirements during OLT were comparable in both groups. In conclus ion, PGE1 therapy during OLT preserves platelet function and prevents the drop in platelet count observed in the control group after revascu larization.