Administration of a recombinant factor viia in patients undergoing liver transplantation for fulminant hepatic failure

Background: Fulminant hepatic failure (FHF) is associated with profound clotting disorder leading to the risk of a major blood loss during liver transplantation (LTx). Application of a recombinant factor VIIa (rFVIIa) which promptly corrects clotting abnormalities remains controversial in the LTx setting. Aim: Retrospective analysis of the effect of rFVIIa on the prothrombin time (PT) and other perioperative parameters in a group of patients transplanted for FHF in our centre.
Material/Methods: Nineteen consecutive patients (9 males, 10 females mean age 33±13) were studied. Clinical diagnoses were as follows: Wilson's - 8 patients; Non-A-non-B hepatitis - 6 patients, Amanita toxicity - 5 patients. All subjects received rFVIIa in the mean dose of 54±16 mcg/kg body mass 10 minutes before skin incision. The PT was measured 15 minutes and 12 hours later. Data are presented as mean ±SD and were analysed with StatView program. P values <0.05 were considered significant.
Results: Rapid correction of PT was observed in all patients (mean PT before injection 37±14 vs. 14±3 after 15 min; p<0.0001). Twelve hours after injection PT was 19±5 (p<0.0001 vs. before injection and p<0.0007 vs. 15 min after injection). Two patients died on 1st and 19[sup]th[/sup] day after LTx. Mean RBC
requirement was 5±4U and FFP was 11±5U. Mean surgery time was 527±126
min and ITU stay 8±9 days. None of the patients developed thromboembolic complications.
Conclusions: Administration of rFVIIa causes rapid improvement of the PT
shortly after injection. It was safe and not associated with any thromboembolic events in our series.

Keywords: Liver Transplantation