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Anesth Analg 2003;96:1230-1231
© 2003 International Anesthesia Research Society

LETTERS TO THE EDITOR

Fibrinolysis During Liver Transplant and Use of Solvent/Detergent Virus-Inactivated Plasma (ESDEP®/Octaplas®)

Bjarte G. Solheim, MD PhD, Anstein Bergan, MD PhD, Frank Brosstad, MD PhD, Robert Innes, MD PhD, and Jan L. Svennevig, MD PhD

Institute of Immunology, Departments of Surgery, Medicine, Anaesthesiology and Thoracic Surgery, Rikshospitalet, University Hospital, Oslo, Norway

To the Editor:

We have with interest read the retrospective observational study by de Jonge et al. (1) of enhanced fibrinolysis during liver transplantation after use of solvent/detergent virus inactivated (SD) plasma. As the authors state, the production method for ESDEP®/Octaplas® (Octa- pharma, Vienna, Austria) reduces the content of {alpha}2-antiplasmin by up to 76% (2–6) . {alpha}2-antiplasmin is a liver synthesized acute-phase serine protease inhibitor of plasmin (7).

Following a decision by our Surgeon General in 1992, SD plasma has totally replaced FFP in Norway since 1993. Since then, more than 250,000 units of Octaplas® have been transfused. So far the product has been used in all types of patients, including neonates. No particular problems with fibrinolysis have been reported after Octaplas® transfusion, however, the serine protease inhibitor Aprotinin, is generally used in patients with severe liver failure (including liver transplantation) and in complicated repeat cardiac surgery. Allogeneic transplant surgery in Norway is centralized to our hospital. We have performed 208 liver transplants between 1993-2001 using Octaplas® without particular problems with fibrinolysis.

Thus the Norwegian experience with Octaplas® does not support the suggestion by de Jonge et al. for routine administration of antifibrinolytic drugs when using SD plasma produced by Octapharma.

References

  1. de Jonge J, Groenland THN, Metselaar HJ, et al. Fibrinolysis during liver transplantation is enhanced by using solvent/detergent virus-inactivated plasma (ESDEP®). Anesth Analg 2002; 94: 1127–31.[Abstract/Free Full Text]
  2. Hellstern P, Sachse H, Schwinn H, Oberfrank K. Manufacture and in vitro characterization of solvent/detergent-treated human plasma. Vox Sang 1992; 63: 178–85.[Web of Science][Medline]
  3. Beeck H, Hellstern P. In vitro characterization of solvent/detergent-treated human plasma and of quarantine fresh frozen plasma. Vox Sang 1998; 74 (Suppl 1): 219–23.
  4. Leebeek FWG, Schipperus MR, van Vliet HHDM. Coagulation factors in solvent/detergent treated plasma. Transfusion 1999; 39: 1150–1.[Medline]
  5. Zeiler T, Wittmann G, Zimmermann R, et al. The effect of virus inactivation on coagulation factors in therapeutic plasma. Br J Haematol 2000; 111: 986–87.
  6. Haubelt H, Blome M, Kiessling AH, et al. Effects of solvent/detergent-treated plasma and fresh-frozen plasma on haemostasis and fibrinolysis in complex coagulopathy following open-heart surgery. Vox Sang 2002; 82: 9–14.[Medline]
  7. Matsuda M, Wakabayashi K, Aoki N, Morioka Y. Alpha 2-Plasmin inhibitor is among acute phase reactants. Thromb Res Suppl. 1980; 17: 527–32.[Medline]



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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2003 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press