الفهرس 
-Pathophysiology and management of end-stage liver diseaseOnly 14 pages are availabe for public view
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Abstract
Liver replacement represents the sole definitive treatment for end-stage liver diseases. Living-donor liver transplantation was first performed in Brazil in 1988, due to a shortage of cadaveric organs. Liver transplantation is the second most common transplant organs surgery, accounting for 21% of all organ transplants.
Hyperfibrinolysis is a common feature of coagulopathy in patients with end stage liver disease, contributing to bleeding and increasing transfusion requirements during orthotopic liver transplantation (OLT).
The coagulopathy that occurs during OLT is multifactorial, resulting from a combination of insufficient procoagulants and thrombocytopenia of end-stage liver disease, along with fibrinolysis occurring during the anhepatic phase and at reperfusion.
Orthotopic liver transplantation (OLT) is a proce¬dure associated with a substantial risk for massive hemorrhage and consequent massive transfusion. When this occurs, it entails considerable use of blood and blood products, with the attendant risks and use of resources.
In addition, greater transfusion requirements are associated with greater incidences of both mortality and postoperative morbidity, related to mod¬ifications of the inflammatory response.
Antifibrinolytics have been used since the early era of liver transplantation in an attempt to minimize blood loss, transfusion requirement, and associated risks and costs, which has shown to be an effective method of controlling and reducing intra-and postoperative bleeding and even avoiding blood transfusions.
Aprotinin, a naturally occurring nonspecific serine protease inhibitor, inhibits fibrinolysis, may reduce platelet dysfunction, and inhibits the inflammatory response that may have beneficial effects on haemodynamics during liver transplantation and on early graft function. It has been shown to decrease blood loss in cardiac surgery. For these reasons, it has been investigated as an agent to poten¬tially reduce blood and blood-product transfusion requirements during OLT.
The purpose of this study is to investigate the effect of the administration of aprotinin to the recipient patients of orthotopic liver transplant intra-operatively on the intra-operative blood loss and the need for transfusion of whole blood and blood products. Also changes in the haemostatic status of the patients as regard haemostatic variables, coagulation & fibrinolytic variables.
This current study showed that aprotinin has the ability to manage and control blood loss during orthotopic liver transplantation and also to decrease the need of blood and blood products transfusion.
The results of current study supported by the recently published European multicenter study suggest¬ing that aprotinin is efficacious in reducing blood loss during OLT and should be considered for this purpose by practitioners in the field.
Also, current study showed that aprotinin has a role in maintaining the level of haemoglobin, haematocrit value and platelet count by playing a role in maintaining haemodynamics during liver transplantation.
During OLT, coagulation is diminished and fibrinolysis is increased, which contrib¬utes to increase bleeding.
Aprotinin has a role in management of haemostasis by playing role in balancing between fibrinolysis and coagulation.
When aprotinin is administered, fibrinolysis is strongly inhibited, but coagulation also is reduced. However, inhibition of coagulation is much weaker, which results in restoration of the haemostatic balance and an overall prohaemostatic effect.
Also, current study concluded that aprotinin makes (PT) and (INR) stable during the (OLT) more than controlled patients and prolongs (aPTT) more than controlled patients.
Aprotinin has a great effect on fibrinolysis by decreasing the CT, D-dimer and FDP level more than controlled patients especially at anhepatic and post reperfusion phase.