Aprotinin reduces red blood cell transfusion in orthotopic liver transplantation: A prospective, randomized, double-blind study

The effect of an aprotinin infusion on blood and blood product transfusion during adult primary orthotopic liver transplantation (OLT) was investigate d in a prospective, randomized, double-blind study. Sixty-three patients we re enrolled; 33 patients were administered an aprotinin regimen of a 1,000, 000-KIU loading dose, followed by a 250,000-KIU/h infusion during surgery, and 30 patients were administered equivalent volumes of normal saline. Red blood cell (RBC) and blood product transfusion intraoperatively and for the first 24 hours postoperatively was by protocol. Intraoperative coagulation testing and thromboelastography (TEG; Hemoscope Corp, Skokie, IL) were per formed. Intraoperative RBC transfusion was significantly less in the aproti nin group versus controls: median, 5 units (interquartile range [IQR], 3 to 9 units) versus 7 units (IQR, 5 to 16 units; P = .0016). No significant di fferences were found for intraoperative blood product transfusion or transf usion of RBCs or blood products in the 24-hour postoperative period. No sig nificant differences were observed in intraoperative coagulation testing or TEG parameters. We conclude that aprotinin infusion reduces RBC transfusio n requirements in OLT.