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CARDIOVASCULAR ANESTHESIA

Fibrinolysis During Liver Transplantation Is Enhanced by Using Solvent/Detergent Virus-Inactivated Plasma (ESDEP^®)

Jeroen de Jonge, MD^*, Theo H. N. Groenland, MD, Herold J. Metselaar, MD PhD, Jan N. M. IJzermans, MD PhD^*, Huub H. D. M. van Vliet, PhD, Loes Visser, MD, and Hugo W. Tilanus, MD PhD^*

Departments of *Surgery, Anesthesiology, Hepato-gastroenterology, and Hematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands

Address correspondence and reprint requests to H. W. Tilanus, MD, PhD, Room H1043, Department of Surgery, Erasmus University Hospital "Dijkzigt," PO Box 2040, 3000 CA Rotterdam, The Netherlands. Address e-mail to tilanus{at}hlkd.azr.nl

After the introduction of solvent/detergent-treated plasma (ESDEP^®) in our hospital, an increased incidence of hyperfibrinolysis was observed (75% vs 29%; P = 0.005) compared with the use of fresh frozen plasma for liver transplantation. To clarify this increased incidence, intraoperative plasma samples of patients treated with fresh frozen plasma or ESDEP were analyzed in a retrospective observational study. During the anhepatic phase, plasma levels of D-dimer (6.58 vs 1.53 µg/mL; P = 0.02) and fibrinogen degradation products (60 vs 23 mg/L; P = 0.018) were significantly higher in patients treated with ESDEP. After reperfusion, differences increased to 23.5 vs 4.7 µg/mL (D-dimer, P = 0.002) and 161 vs 57 mg/L (fibrinogen degradation products, P = 0.001). The amount of plasma received per packed red blood cell concentrate, clotting tests, and levels of individual clotting factors did not show significant differences between the groups. ₂-Antiplasmin levels, however, were significantly lower in patients receiving ESDEP during the anhepatic phase (0.37 vs 0.65 IU/mL; P < 0.001) and after reperfusion (0.27 vs 0.58 IU/mL; P = 0.001). Analysis of ₂-antiplasmin levels in ESDEP alone showed a reduction to 0.28 IU/mL (normal >0.95 IU/mL) because of the solvent/detergent process. Therapeutic consequences for the use of ESDEP in orthotopic liver transplantation are discussed in view of an increased incidence of hyperfibrinolysis caused by reduced levels of ₂-antiplasmin in the solvent/detergent-treated plasma.

IMPLICATIONS: The use of solvent/detergent virus-inactivated plasma is of increasing importance in the prevention of human immunodeficiency virus and hepatitis C virus transmission. Since the use of this plasma during orthotopic liver transplantation has increased, the incidence of hyperfibrinolysis was observed. Clotting analysis of the patients revealed small ₂-antiplasmin concentrations because of the solvent/detergent process.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999