INCREASED TISSUE-TYPE PLASMINOGEN-ACTIVATOR ACTIVITY IN ORTHOTOPIC BUT NOT HETEROTOPIC LIVER-TRANSPLANTATION - THE ROLE OF THE ANHEPATIC PERIOD

被引:22
作者
BAKKER, CM
METSELAAR, HJ
GROENLAND, TN
GOMES, MJ
KNOT, EAR
HESSELINK, EJ
SCHALM, SW
STIBBE, J
TERPSTRA, OT
机构
[1] ERASMUS UNIV,HOSP DIJKZIGT,DEPT SURG,3015 GD ROTTERDAM,NETHERLANDS
[2] ERASMUS UNIV,HOSP DIJKZIGT,DEPT HEMATOL,3015 GD ROTTERDAM,NETHERLANDS
[3] ERASMUS UNIV,HOSP DIJKZIGT,DEPT ANESTHESIOL,3015 GD ROTTERDAM,NETHERLANDS
关键词
D O I
10.1002/hep.1840160219
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The major cause of the increased tissue-type plasminogen activator activity during orthotopic liver transplantation is still unclear. Both the lack of hepatic clearance of tissue-type plasminogen activator in the anhepatic period and increased endothelial release from the graft on reperfusion have been proposed as the major causes. Heterotopic liver transplantation avoids the resection of the host liver and is a useful model to help differentiate between these two possibilities. In this study the fibrinolytic system was evaluated in 10 orthotopic liver transplantations, 18 heterotopic liver transplantations and a control group of 10 partial hepatic resections. A marked increment in tissue-type plasminogen activator activity, from 0.2 to 5.2 IU/ml (p < 0.02), was observed during the anhepatic period of orthotopic liver transplantation, which rapidly normalized after reperfusion. In contrast, tissue-type plasminogen activator activity levels remained normal in heterotopic liver transplantation and partial hepatic resections. In orthotopic liver transplantation and in heterotopic liver transplantation no increase occurred in tissue-type plasminogen activator activity after reperfusion. The first venous hepatic outflow after reperfusion did not contain elevated tissue-type plasminogen activator activity levels. Plasma degradation products of fibrin and fibrinogen increased during the anhepatic period of orthotopic liver transplantation (from 2.60 to 8.80-mu-g/ml [p < 0.008] and from 0.40 to 1.60-mu-g/ml [p < 0.04], respectively) and remained elevated thereafter. In heterotopic liver transplantation and partial hepatic resections these levels remained low. In conclusion, the lack of hepatic clearance during the anhepatic period is probably the most important factor in the evolution of increased tissue-type plasminogen activator activity during orthotopic liver transplantation.
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页码:404 / 408
页数:5
相关论文
共 18 条
  • [1] INTRAOPERATIVE EVOLUTION OF COAGULATION PARAMETERS AND T-PA PAI BALANCE IN ORTHOTOPIC LIVER-TRANSPLANTATION
    ARNOUX, D
    BOUTIERE, B
    HOUVENAEGHEL, M
    ROUSSETROUVIERE, A
    LETREUT, P
    SAMPOL, J
    [J]. THROMBOSIS RESEARCH, 1989, 55 (03) : 319 - 328
  • [3] DZIK WH, 1988, BLOOD, V71, P1090
  • [4] GROTH CG, 1969, EXPERIENCE HEPATIC T, P159
  • [5] HARPER PL, 1989, TRANSPLANTATION, V48, P603
  • [6] CURRENT STATUS OF HEPATIC TRANSPLANTATION
    IWATSUKI, S
    SHAW, BW
    STARZL, TE
    [J]. SEMINARS IN LIVER DISEASE, 1983, 3 (03) : 173 - 180
  • [7] FIBRINOLYSIS DURING MAJOR ABDOMINAL-SURGERY
    JOHNSON, EJ
    HARIMAN, H
    HAMPTON, KK
    GRANT, PJ
    DAVIES, JA
    PRENTICE, CRM
    [J]. FIBRINOLYSIS, 1990, 4 (03) : 147 - 151
  • [8] LIVER-TRANSPLANTATION - INTRAOPERATIVE CHANGES IN COAGULATION-FACTORS IN 100 1ST TRANSPLANTS
    LEWIS, JH
    BONTEMPO, FA
    AWAD, SA
    KANG, YG
    KISS, JE
    RAGNI, MV
    SPERO, JA
    STARZL, TE
    [J]. HEPATOLOGY, 1989, 9 (05) : 710 - 714
  • [9] LIVER-TRANSPLANTATION - AN OVERVIEW
    MADDREY, WC
    VANTHIEL, DH
    [J]. HEPATOLOGY, 1988, 8 (04) : 948 - 959
  • [10] RECOVERY OF FAILING LIVER AFTER AUXILIARY HETEROTOPIC TRANSPLANTATION
    METSELAAR, HJ
    HESSELINK, EJ
    DERAVE, S
    TENKATE, FJW
    LAMERIS, JS
    GROENLAND, THN
    REUVERS, CB
    WEIMAR, W
    TERPSTRA, OT
    SCHALM, SW
    [J]. LANCET, 1990, 335 (8698) : 1156 - 1157