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Effect of Donor-Disseminated Intravascular Coagulation in Liver Transplantation

Effect of Donor-Disseminated Intravascular Coagulation in Liver Transplantation Abstract • It is not known whether disseminated intravascular coagulation, present in a large percentage of organ donors, affects patient outcome after liver transplantation. We reviewed our first 55 liver transplantations and identified 10 donors with disseminated intravascular coagulation. We compared the perioperative courses of the 10 recipients of these transplanted livers with those of 10 matched controls whose donors did not have disseminated intravascular coagulation. Disseminated intravascular coagulation recipients did not require more blood products during or after surgery; their hepatic enzyme levels and prothrombin times after surgery were not statistically significantly higher than those of the controls. There was no difference in hospital stay, number of episodes of rejection, retransplantations, or deaths. The presence of disseminated intravascular coagulation in donors did not adversely affect graft function or patient outcome and should not be a sole criterion for rejecting a liver for transplantation. (Arch Surg. 1991;126:1292-1296) References 1. Baker WF. Clinical aspects of disseminated intravascular coagulation: a clinician's point of view . Semin Thromb Hemost . 1989;15:1-46.Crossref 2. Shamash FS, Oh HK, Lee MW, Dienst SG. Kidney retrieval from cadaver donors with disseminated intravascular coagulopathy . Curr Surg . 1989;46:6-9. 3. Makowka L, Gordon RD, Todo S, et al. Analysis of donor criteria for the prediction of outcome in clinical liver transplantation . Transplant Proc . 1987;19:2378-2382. 4. Mimeault R, Grant D, Ghent C, Duff J, Wall W. Analysis of donor and recipient variables and early graft function after orthotopic liver transplantation . Transplant Proc . 1989;21:2355. 5. Wall WJ, Mimeault R, Grant D, Bloch M. The use of older donor livers for hepatic transplantation . Transplantation . 1990;49:377-381.Crossref 6. Greig PD, Forster J, Superina RA, et al. Donor-specific factors predict graft function following liver transplantation . Transplant Proc . 1990;20:2072-2073. 7. Lamesch P, Ringe B, Neuhaus P, Burderski M, Oellerich M, Pichlmayr R. Qualitative assessment of liver function after hypovolemic, hypoxemic, and ischemic shock in a transplantation model . Transplant Proc . 1988;20:994-995. 8. Kahn D, Makowka L, Gavaler J, Starzl TE, Van Thiel DH. The outcome after clinical liver transplantation is influenced by the gender of the donor . Hepatology . 1988;8:1225. 9. Stratta RJ, Wood RP, Langnas AN, et al. Donor selection for orthotopic liver transplantation: lack of an effect of gender or cytomegalovirus (CMV) status . Transplant Proc . 1990;22:410-413. 10. Pillay P, Van Thiel DH, Gavaler JS, Starzl TE. Donor gender does not affect the liver transplantation outcome in children . Dig Dis Sci . 1990;35:686-689.Crossref 11. Howard TK, Klintmalm GB, Cofer JB, et al. The influence of preservation injury on rejection in the hepatic transplant recipient . Transplantation . 1990;49:103-107.Crossref 12. Pruim J, Vanwoerden WF, Knol E, et al. Donor data in liver grafts with primary non-function: a preliminary analysis by the European liver registry . Transplant Proc . 1989;21:2382-2384. 13. Burdelski M, Oellerich M, Raude E, et al. A novel approach to assessment of liver function in donors . Transplant Proc . 1988;20:591-593. 14. Markin RS, Wood RP, Stratta RJ, et al. Predictive value of intraoperative liver biopsies in donor organs in the patients undergoing orthotopic liver transplantation . Transplant Proc . 1990;22:418-419. 15. Olthoff KM, Millis JM, Imagawa DK, et al. Comparison of UW solution and Euro-Collins solutions for cold preservation of human liver grafts . Transplantation . 1990;49:284-290.Crossref 16. Kennedy EM, Wood RP, Shaw BW. Primary nonfunction: is there a contribution from the back table bath? Transplantation . 1990;49:739-743.Crossref 17. Gordon RD, Iwatsuki S, Esquivel CO, et al. Liver transplantation across ABO blood groups . Surgery . 1986;100:342-348. 18. Wilde JT, Roberts KM, Greaves M, Preston FE. Association between necropsy evidence of disseminated intravascular coagulation and coagulation variables before death in patients in intensive care units . J Clin Pathol . 1989;41:138-142.Crossref 19. Bick RL. Disseminated intravascular coagulation and related syndromes: a clinical review . Semin Thromb Hemost . 1988;14:299-324.Crossref 20. Carr JM, McKinney M, McDonagh J. Diagnosis of disseminated intravascular coagulation: role of D-dimer . Am J Clin Pathol . 1989;91:280-287. 21. Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation: findings in 346 patients . Thromb Haemost . 1990;43:28-33. 22. Porte RJ, Knot EA, Bontempo PA. Hemostasis in liver transplantation . Gastroenterology . 1989;97:488-501. 23. Harper PL, Luddington RJ, Jennings I, et al. Coagulation changes following hepatic revascularization during liver transplantation . Transplantation . 1989;48:603-607. 24. Lewis JH, Bontemp FA, Awad SA, et al. Liver transplantation: intraoperative changes in coagulation factors in 100 first transplants . Hepatology . 1989;9:710-714.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Effect of Donor-Disseminated Intravascular Coagulation in Liver Transplantation

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410340134019
Publisher site
See Article on Publisher Site

Abstract

Abstract • It is not known whether disseminated intravascular coagulation, present in a large percentage of organ donors, affects patient outcome after liver transplantation. We reviewed our first 55 liver transplantations and identified 10 donors with disseminated intravascular coagulation. We compared the perioperative courses of the 10 recipients of these transplanted livers with those of 10 matched controls whose donors did not have disseminated intravascular coagulation. Disseminated intravascular coagulation recipients did not require more blood products during or after surgery; their hepatic enzyme levels and prothrombin times after surgery were not statistically significantly higher than those of the controls. There was no difference in hospital stay, number of episodes of rejection, retransplantations, or deaths. The presence of disseminated intravascular coagulation in donors did not adversely affect graft function or patient outcome and should not be a sole criterion for rejecting a liver for transplantation. (Arch Surg. 1991;126:1292-1296) References 1. Baker WF. Clinical aspects of disseminated intravascular coagulation: a clinician's point of view . Semin Thromb Hemost . 1989;15:1-46.Crossref 2. Shamash FS, Oh HK, Lee MW, Dienst SG. Kidney retrieval from cadaver donors with disseminated intravascular coagulopathy . Curr Surg . 1989;46:6-9. 3. Makowka L, Gordon RD, Todo S, et al. Analysis of donor criteria for the prediction of outcome in clinical liver transplantation . Transplant Proc . 1987;19:2378-2382. 4. Mimeault R, Grant D, Ghent C, Duff J, Wall W. Analysis of donor and recipient variables and early graft function after orthotopic liver transplantation . Transplant Proc . 1989;21:2355. 5. Wall WJ, Mimeault R, Grant D, Bloch M. The use of older donor livers for hepatic transplantation . Transplantation . 1990;49:377-381.Crossref 6. Greig PD, Forster J, Superina RA, et al. Donor-specific factors predict graft function following liver transplantation . Transplant Proc . 1990;20:2072-2073. 7. Lamesch P, Ringe B, Neuhaus P, Burderski M, Oellerich M, Pichlmayr R. Qualitative assessment of liver function after hypovolemic, hypoxemic, and ischemic shock in a transplantation model . Transplant Proc . 1988;20:994-995. 8. Kahn D, Makowka L, Gavaler J, Starzl TE, Van Thiel DH. The outcome after clinical liver transplantation is influenced by the gender of the donor . Hepatology . 1988;8:1225. 9. Stratta RJ, Wood RP, Langnas AN, et al. Donor selection for orthotopic liver transplantation: lack of an effect of gender or cytomegalovirus (CMV) status . Transplant Proc . 1990;22:410-413. 10. Pillay P, Van Thiel DH, Gavaler JS, Starzl TE. Donor gender does not affect the liver transplantation outcome in children . Dig Dis Sci . 1990;35:686-689.Crossref 11. Howard TK, Klintmalm GB, Cofer JB, et al. The influence of preservation injury on rejection in the hepatic transplant recipient . Transplantation . 1990;49:103-107.Crossref 12. Pruim J, Vanwoerden WF, Knol E, et al. Donor data in liver grafts with primary non-function: a preliminary analysis by the European liver registry . Transplant Proc . 1989;21:2382-2384. 13. Burdelski M, Oellerich M, Raude E, et al. A novel approach to assessment of liver function in donors . Transplant Proc . 1988;20:591-593. 14. Markin RS, Wood RP, Stratta RJ, et al. Predictive value of intraoperative liver biopsies in donor organs in the patients undergoing orthotopic liver transplantation . Transplant Proc . 1990;22:418-419. 15. Olthoff KM, Millis JM, Imagawa DK, et al. Comparison of UW solution and Euro-Collins solutions for cold preservation of human liver grafts . Transplantation . 1990;49:284-290.Crossref 16. Kennedy EM, Wood RP, Shaw BW. Primary nonfunction: is there a contribution from the back table bath? Transplantation . 1990;49:739-743.Crossref 17. Gordon RD, Iwatsuki S, Esquivel CO, et al. Liver transplantation across ABO blood groups . Surgery . 1986;100:342-348. 18. Wilde JT, Roberts KM, Greaves M, Preston FE. Association between necropsy evidence of disseminated intravascular coagulation and coagulation variables before death in patients in intensive care units . J Clin Pathol . 1989;41:138-142.Crossref 19. Bick RL. Disseminated intravascular coagulation and related syndromes: a clinical review . Semin Thromb Hemost . 1988;14:299-324.Crossref 20. Carr JM, McKinney M, McDonagh J. Diagnosis of disseminated intravascular coagulation: role of D-dimer . Am J Clin Pathol . 1989;91:280-287. 21. Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation: findings in 346 patients . Thromb Haemost . 1990;43:28-33. 22. Porte RJ, Knot EA, Bontempo PA. Hemostasis in liver transplantation . Gastroenterology . 1989;97:488-501. 23. Harper PL, Luddington RJ, Jennings I, et al. Coagulation changes following hepatic revascularization during liver transplantation . Transplantation . 1989;48:603-607. 24. Lewis JH, Bontemp FA, Awad SA, et al. Liver transplantation: intraoperative changes in coagulation factors in 100 first transplants . Hepatology . 1989;9:710-714.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1991

References