SYSTEMIC EFFECTS OF TISSUE PLASMINOGEN ACTIVATOR-ASSOCIATED FIBRINOLYSIS AND ITS RELATION TO THROMBIN GENERATION IN ORTHOTOPIC LIVER-TRANSPLANTATION
SYSTEMIC EFFECTS OF TISSUE PLASMINOGEN ACTIVATOR-ASSOCIATED FIBRINOLYSIS AND ITS RELATION TO THROMBIN GENERATION IN ORTHOTOPIC LIVER-TRANSPLANTATION
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DOI：
10.1097/00007890-198906000-00012
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发表时间：
1989-06-01
期刊：
影响因子：
6.2
通讯作者：
STARZL, TE
中科院分区：
文献类型：
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作者：
PORTE, RJ;BONTEMPO, FA;STARZL, TE
原位肝移植常伴有纤维蛋白溶解亢进，其病因和临床意义尚不清楚。本文对20例原位肝移植术后纤溶亢进的发生及其对全身的影响进行了研究。严重的纤溶被定义为存在时优球蛋白凝块溶解时间和全血凝块溶解时间，通过血栓弹力图测量，分别短于60和90分钟，在手术过程中的某个时间。根据这些标准，7例患者有轻微的纤溶（组I），13例患者有严重的纤溶（组II）。在组II中，组织型纤溶酶原激活物（t-PA）的活性逐渐增加，在无肝阶段，随后的“爆炸性”增加后立即移植物再灌注（P = 0.0004，与组I相比），和纤溶酶原激活物抑制剂（派）的活性减少。血浆纤维蛋白原和纤维蛋白降解产物与t-PA活性平行增加，Ⅱ组在再灌注后45 min显著高于Ⅰ组（P < 0.04）。凝血酶-抗凝血酶III复合物在两组中显示出相同的稳定增加，表明t-PA活性增加与凝血酶形成无关。内皮细胞释放增加和肝脏清除率降低可能导致t-PA活性增加。移植物再灌注后t-PA相关的纤维蛋白原和纤维蛋白的破坏与这一时期常见的严重渗血的临床体征一致。这些观察结果可能具有重要的临床意义，为治疗出血的患者接受正交肝移植。
Orthotopic liver transplantation is frequently associated with hyperfibrinolysis, the origin and clinical relevance of which is largely unknown. In 20 orthotopic liver transplantation, we studied the occurrence and systemic effects of hyperfibrinolysis. Severe fibrinolysis was defined to be present when the euglobulin-clot lysis time and the whole-blood-clot lysis time, as measured by thrombelastography, were shorter than 60 and 90 min, respectively, at some time during the operation. Based on these criteria, 7 patients had minimal fibrinolysis (group I), and 13 patients had severe fibrinolysis (group II). In group II a gradual increase of tissue-type plasminogen activator (t-PA) activity was seen during the anhepatic stage, followed by an "explosive" increase immediately after graft reperfusion (P = 0.0004, compared with group I), and a reduction of plasminogen activator inhibitor (PAI) activity. Plasma degradation products of fibrinogen and fibrin increased parallel to t-PA activity and levels were significantly higher at 45 min after graft reperfusion in group II compared with group I (P < 0.04). Thrombin-antithrombin III complexes showed an identical steady increase in both groups, indicating that increased t-PA activity was not related to thrombin formation. A combination of increased endothelial release and reduced hepatic clearance may have caused the increased t-PA activity. The t-PA-associated destruction of fibrinogen and fibrin after graft reperfusion is consistent with the clinical signs of severe oozing often seen in this period. These observations may have important clinical implications for the treatment of bleeding in patients undergoing orthotropic liver transplantation.