الفهرس 
Indications for liver transplantationOnly 14 pages are availabe for public view
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Abstract
Liver transplantation is the main treatment for patients with end-stage liver
disease not responding to medical treatment. Liver transplantation is frequently
accompanied by considerable bleeding complications and massive transfusion
due to severe coagulopathies. While the increased risk of bleeding in cirrhotic
patients has long been the center of attention, it is important to remember that
these patients are also at risk for serious thrombotic events both in the peripheral
and portal venous systems.
The value of the most commonly used routine laboratory coagulation tests
prothrombin time (PT), activated partial thromboplastin time (aPTT), and
platelets count) is questionable in the perioperative setting due to their long
turnaround time and their inability to adequately reflect the complex changes in
hemostasis in patients with liver cirrhosis. Thromboelastometry offers rapid,
comprehensive, ̊̊and ̊̊global ̊̊clinical ̊̊assessment ̊̊of ̊̊the ̊̊patients’ ̊̊coagulation ̊̊status, ̊̊
as demonstrated by several studies.
Platelets are activated via different pathways including Arachidonic acid
(AA), Adenosine diphosphate receptor (ADP) or thrombin pathways. In
Rotational thromboelastometry (ROTEM) (EXTEM, INTEM), the platelets
dysfunction cannot be detected. The ROTEM platelet system is a new module
that could be added to the ROTEM. This allows a deeper analysis of the primary
hemostasis of the patient along with that of coagulation. The measurement is
based on true impedance aggregometry which allows the measurement of
platelets aggregation in whole blood samples. The two different assays (both
thromboelastometry and plateletsaggregometry) can be run together at the same
time on the same system, guiding clinicians in making the correct diagnosis of bleeding risk or in properly tailoring the anti¬platelet therapy directly in
perioperative period.
he study aimed to compare the effect of splenectomy on coagulation
changes in particular platelets behavior and function intraoperative and
postoperative in recipient of small for size liver transplantation with those
undergoing liver transplantation without splenectomy. The secondary aim is to
record the possible bleeding and thrombotic events postoperative and the value
of modulating antiplatelet drugs for prevention of such complication.
This prospective observational study was carried out on 40 consecutive
recipients with ESLD scheduled for adult living donor liver transplantation
(ALDLT) recruited: Splenectomy (n=20) vs. none (n=20). Patients on
preoperative oral anticoagulant, antiplatelet or any factor that could interfere with
coagulation or platelet function were excluded.
On POD1 and POD3 the results of our current study demonstrated that the
platelet function and count were not different from that after reperfusion phase.
Platelet function and fibrinogen concentration required two weeks to
recover as in results. However, this recovery exceeded the normal reference range in a few recipients.