A new finding in liver transplantation and antifibrinolytics?

Orthotopic liver transplantation (OLT) is associated with severe bleeding and considerable transfusion requirements.

There are several reasons for this severe bleeding in OLT. Hemostatic abnormalities remain a major cause.

This study, performed by a team led by Professor Wang Xuehao, is to be published in the March 7, 2008 issue of the World Journal of Gastroenterology.

Aprotinin, a serine protease inhibitor, is used increasingly often in surgeries during operations such as cardiac surgery and liver transplantation to reduce bleeding and transfusion .We performed a meta-analysis to study the effect of aprotinin used in OLT on the intraoperative requirement of blood products and the postoperative outcomes. This study clearly showed that aprotinin can reduce the intraoperative requirement of blood products and has no significant effect on the incidence of laparotomy for bleeding, thromboembolic events and mortality.

In the view of the authors, there are still some conflicting results on whether aprotinin can reduce blood loss or requirement of transfusion in orthotopic liver transplantation, and whether it can be beneficial to the postoperative outcomes. A systematic review of the literature was performed in the electronic database of Medline and the Clinical Trials Registry Databases to study the effect of aprotinin used in OLT on the intraoperative requirement of blood products and on the incidence of laparotomy for bleeding, thrombotic events and mortality.

Using meta-analysis as the statistical method, this research was performed by doctors from the Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University.

More clinic researches are needed to confirm the result.