Activated recombinant factor VII in orthotopic liver transplantation

Orthotopic liver transplantation (OLT) is affected by important alterations of hemostasis. The aim of this study was to evaluate the efficacy of recombinant factor VII activated (rFVIIa) to reduce intraoperative bleeding during OLT. Methods. Twenty OLT patients were assigned in double-blind way to a rFVIIa group or a control group. Inclusion criteria were hemoglobin 8 g/dL: INR 1,5 and fibrinogen 100 mg/dL. We administered a single bouls of rFVIIa (40 g/kg) or placebo. We determined INR, partial thromboplastin time, fibrinogen, ATIII, and blood cell counts. Blood products were administered as follows: 4 units of fresh frozen plasma when INR 1.5, and 1 unit of RBC for Hb 10 g/dL. The study ended 6 hours after the bolus. Results. No thromboembolic events occurred. The INR was different between rFVIIa group and the controls at T0 (1.9 vs 1.6 P .021) and during T1 (1.2 vs 1.6 P .004). The total transfused red blood cells was 300 mL 133 in rFVIIa group and 570 mL 111 in control group (P .017). The total fresh frozen plasma was 600 mL 154 in rFVIIa group and 1400 mL 187 in control group (P .001). Total blood loss was greater in the control group than the rFVIIa group: 1140 mL 112 vs 740 mL 131 (P .049). Discussion. The use of rFVIIa during OLT can reduce the risk of bleeding during surgery. The literature has described cases who did not benefit from the treatment. An adequate cut-off of INR, allowed us to treat only patients at greater bleeding risk.