Patrassi G M, Viero M, Sartori M T, De Silvestro G, Rossaro L, Burra P, Nolli M L, Piccinni P, Bassi N
Fourth Chair of Internal Medicine, University of Padua Medical School, Italy.
Transfusion. 1994 Jun;34(6):507-11. doi: 10.1046/j.1537-2995.1994.34694295066.x.
Bleeding complications frequently occur during orthotopic liver transplantation (OLT), particularly in patients with liver cirrhosis. Enhanced fibrinolytic activity in plasma was seen to play a key role in the development of the hemostatic disorder and of hemorrhages. Aprotinin, a serine protease inhibitor, has been used in the prevention and/or treatment of hyperfibrinolytic states.
In the present study, the effect of aprotinin on bleeding complications and transfusion requirements was investigated in OLT patients with liver cirrhosis. Seven consecutive cirrhotic patients undergoing OLT were infused with aprotinin following an original protocol (1,000,000-KIU intravenous loading dose plus 500,000 kallikrein-inhibitory units per hour until skin closure). Seven previous cirrhotic OLT patients not receiving aprotinin were used as controls.
In the treated group, a significant decrease in the number of transfused units of packed red cells (48.7%, p < 0.01), fresh-frozen plasma (24.4%, p < 0.05), platelets (35.9%, p < 0.01), and autologous blood (55.2%, p < 0.01) was observed as compared with the control group. Moreover, the mean length of operation was significantly shorter in the aprotinin-infused patients than in untreated patients (8.3 +/- 1.2 vs. 10.1 +/- 1.8 hours, respectively; p < 0.01)). In the aprotinin-treated group, the antifibrinolytic efficacy was confirmed by the lack of increase in D-dimer levels and decrease of fibrinogen in plasma; on the contrary, these changes were always seen in the group not receiving aprotinin.
Infusion of aprotinin during OLT in cirrhotic patients can be recommended for the prevention of hyperfibrinolysis-triggered bleeding, thus reducing transfusion requirements. A possible protective effect on the primary nonfunction of the grafted liver is suggested.
原位肝移植（OLT）过程中经常发生出血并发症，尤其是在肝硬化患者中。血浆中增强的纤溶活性被认为在止血障碍和出血的发生中起关键作用。抑肽酶，一种丝氨酸蛋白酶抑制剂，已被用于预防和/或治疗高纤溶状态。
在本研究中，调查了抑肽酶对肝硬化OLT患者出血并发症和输血需求的影响。按照原始方案，对7例连续接受OLT的肝硬化患者输注抑肽酶（静脉负荷剂量1,000,000国际单位，随后每小时500,000激肽释放酶抑制单位，直至皮肤缝合）。将7例先前接受OLT但未接受抑肽酶治疗的肝硬化患者作为对照。
与对照组相比，治疗组输注的红细胞悬液单位数量（减少48.7%，p<0.01）、新鲜冰冻血浆（减少24.4%，p<0.05）、血小板（减少35.9%，p<0.01）和自体血（减少55.2%，p<0.01）均显著减少。此外，输注抑肽酶的患者平均手术时间明显短于未治疗患者（分别为8.3±1.2小时和10.1±1.8小时；p<0.01）。在抑肽酶治疗组中，血浆D-二聚体水平未升高且纤维蛋白原减少，证实了其抗纤溶疗效；相反，在未接受抑肽酶治疗的组中总是出现这些变化。
对于肝硬化患者，OLT期间输注抑肽酶可推荐用于预防高纤溶引发的出血，从而减少输血需求。提示对移植肝原发性无功能可能有保护作用。
