الفهرس | Only 14 pages are availabe for public view |
Abstract Liver transplantation is the main treatment for patients with end-stage liver disease not responding to medical treatment. Liver transplantation is frequently accompanied by considerable bleeding complications and massive transfusion due to severe coagulopathies. While the increased risk of bleeding in cirrhotic patients has long been the center of attention, it is important to remember that these patients are also at risk for serious thrombotic events both in the peripheral and portal venous systems. The value of the most commonly used routine laboratory coagulation tests prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelets count) is questionable in the perioperative setting due to their long turnaround time and their inability to adequately reflect the complex changes in hemostasis in patients with liver cirrhosis. Thromboelastometry offers rapid, comprehensive, ̊̊and ̊̊global ̊̊clinical ̊̊assessment ̊̊of ̊̊the ̊̊patients’ ̊̊coagulation ̊̊status, ̊̊ as demonstrated by several studies. Platelets are activated via different pathways including Arachidonic acid (AA), Adenosine diphosphate receptor (ADP) or thrombin pathways. In Rotational thromboelastometry (ROTEM) (EXTEM, INTEM), the platelets dysfunction cannot be detected. The ROTEM platelet system is a new module that could be added to the ROTEM. This allows a deeper analysis of the primary hemostasis of the patient along with that of coagulation. The measurement is based on true impedance aggregometry which allows the measurement of platelets aggregation in whole blood samples. The two different assays (both thromboelastometry and plateletsaggregometry) can be run together at the same time on the same system, guiding clinicians in making the correct diagnosis of bleeding risk or in properly tailoring the anti¬platelet therapy directly in perioperative period. he study aimed to compare the effect of splenectomy on coagulation changes in particular platelets behavior and function intraoperative and postoperative in recipient of small for size liver transplantation with those undergoing liver transplantation without splenectomy. The secondary aim is to record the possible bleeding and thrombotic events postoperative and the value of modulating antiplatelet drugs for prevention of such complication. This prospective observational study was carried out on 40 consecutive recipients with ESLD scheduled for adult living donor liver transplantation (ALDLT) recruited: Splenectomy (n=20) vs. none (n=20). Patients on preoperative oral anticoagulant, antiplatelet or any factor that could interfere with coagulation or platelet function were excluded. On POD1 and POD3 the results of our current study demonstrated that the platelet function and count were not different from that after reperfusion phase. Platelet function and fibrinogen concentration required two weeks to recover as in results. However, this recovery exceeded the normal reference range in a few recipients. |