PERIOPERATIVE DYNAMICS OF HEMOSTASIS SYSTEM PARAMETERS IN LIVER LOBE RECIPIENTS
Keywords:
liver transplantation; thrombohemorrhagic complications; endothelial dysfunction; coagulation factors; hemostasis.Abstract
Aim: to study the dynamics of the parameters of the hemostasis system in the early postoperative period and to identify the recovery time of the level of pro- and anticoagulants synthesized by the liver in liver lobe recipients from a living related donor. 29 recipients and 29 related liver lobe donors who received treatment at the State Institution "RSSPMCS named after academician V. Vakhidov" in the period from april 2022 to october 2023. The parameters of the hemostasis system were determined in recipients with uncomplicated course of the postoperative period. With an uncomplicated course of the perioperative period, the synthesis of natural anticoagulants lags behind the synthesis of coagulation factors and the activity of the fibrinolytic system depends on the course of the postoperative period. Recipients after LT have signs of endothelial activation, but not its damage, as evidenced by the level of vWFag, vWFact, when vWFag decreases with persisting high vWFact and in in the future, there is a tendency to normalize these indicators to the level of the reference interval by 10 days after the LT. With an uncomplicated course of the perioperative period, compensation in the hemostasis system occurs even with a low level of coagulation factors on day 10 of LT, when TT and PTT are within the reference interval and INR is lengthened by 1.3 times, AT-III is reduced by 1.7 times, protein C and S are reduced by 1.5 and 1.6 times relative to donors accordingly (p<0.05).
References
Grigorieva K.N., Bitsadze V.O., Khizroeva D.H., Tsibizova V.I., Tretyakova M.V., Blinov D.V., Pankratieva L.L., Hashimova N.R., Yakubova F.E., Antonova A.S., Gris J.-K., Elalami I., Makatsaria A.D. Prognostic value of the von Willebrand factor in clinical practice //Obstetrics, Gynecology and Reproduction - 2022;16(5):588–599. https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.363.(in Russ).
Medeubekov U.S., Kuandykov T.K., Mutagirov V.V. Assessment of hemostasis and its correction in patients after liver transplantation // Bulletin of Surgery of Kazakhstan.-2016.-No.3.-p.30-33. (in Russ).
Moisyuk Ya.G., Malinovskaya Yu.O., Bogomolov P.O. Liver transplantation. Modern achievements and problems // Medsi Bulletin - 2017.-№ 29. (in Russ).
EASL Clinical Practice Guidelines: Liver transplantation // Journal of Hepatology 2016 vol. 64; 433–485
Bezinover D., Molly F. Deacutis, Priti G. Dalal1, Robert P. Moore, Jonathan G. Stine, Ming Wang,Ethan Reeder, Christopher S. Hollenbeak. Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation // HPB.- 2019, 21, 370–378
Borst AJ, Sudan DL, Wang LA, Neuss MJ, Rothman JA, Ortel TL. Bleeding and thrombotic complications of pediatric liver transplant.//Pediatr Blood Cancer. 2018;65(5):e26955
Feltracco P., Stefania Barbieri, Umberto Cillo, Giacomo Zanus, Marco Senzolo, Ori C. Perioperative thrombotic complications in liver transplantation // World J Gastroenterol 2015 July 14; 21(26): 8004-8013
Lisman T, Caldwell SH, Burroughs AK, Northup PG, Senzolo M, Stravitz RT, Tripodi A, Trotter JF, Valla DC, Porte RJ; Coagulation in Liver Disease Study Group. Hemostasis and thrombosis in patients with liver disease: the ups and downs // J Hepatol 2010; 53:362-371
Lo C.M., Fan S.Т., Liu C.L. et al. Lessons learned from one hundred right lobe living donor liver transplants // Ann. Surg. 2004. V. 240. № 1. P. 151–158
Lo C.M. Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers // Transplantation. 2003. V. 15. № 75. P. 12–15
Matthias Hartmann, Cynthia Szalai, Fuat H Saner. Hemostasis in liver transplantation: Pathophysiology,monitoring, and treatment // World J Gastroenterol 2016 January 28; 22(4): 1541-1550
Podoplelova N.A., Nechipurenko D.Y., Ignatova A.A., Sveshnikova A.N., Panteleev M.A.. Procoagulant platelets: Mechanisms of generation and action // Hämostaseologie. 2021.-V.41 (2), P.146–153
Soltys K, Caroline Lemoine, Xingyu Zhang, Rukhmi Bhat, John Bucuvalas, Sara Rasmussen, Rene Romero, Irini Batsis, Blayne Sayed, John Tunno. Factors associated with thrombotic and hemorrhagic complications in pediatric liver transplant: A multi-center analysis from the Starzl Network for Excellence in Pediatric Transplantation // 2022.-https://doi.org/10.1111/petr.14521
Shakhanova Sh.Sh., Abdurakhmonov J.A., Rakhimov, N.M.. (2023). Targeted therapy in the palliative treatment of platinum-resistant recurrent ovarian cancer complicated by ascites. The American Journal of Medical Sciences and Pharmaceutical Research, 5(08), 77–81.
Wada H, Usui M, Sakuragawa N. Hemostatic abnormalities and liver diseases. Semin Thromb Hemost. 2008;34:772–778
Wang SC, Shieh JF, Chang KY, Chu YC, Liu CS, Loong CC, Chan KH, Mandell S, Tsou MY. Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proc. 2010;42:2590–2593
