Recombinant factor VIIa reduces transfusion requirements in liver transplant patients with high MELD scores
Article first published online: 30 MAR 2006
Volume 16, Issue 2, pages 93–100, April 2006
How to Cite
Niemann, C. U., Behrends, M., Quan, D., Eilers, H., Gropper, M. A., Roberts, J. P. and Hirose, R. (2006), Recombinant factor VIIa reduces transfusion requirements in liver transplant patients with high MELD scores. Transfusion Medicine, 16: 93–100. doi: 10.1111/j.1365-3148.2006.00653.x
- Issue published online: 30 MAR 2006
- Article first published online: 30 MAR 2006
- Received 6 April 2005; accepted for publication 20 October 2005
- liver transplantation;
- recombinant factor VIIa;
summary. Patients undergoing orthotopic liver transplantation (OLT) often experience significant coagulopathy and remain at risk for excessive blood loss and massive transfusion. The ability of recombinant factor VIIa (rFVIIa) to reduce transfusion requirements during OLT has not been well established.
This retrospective study investigates whether rFVIIa reduces transfusion requirements in liver transplant patients with a significantly prolonged prothrombin time (PT) and a model of end-stage liver disease (MELD) score of >20. Eleven patients received a single dose of rFVIIa (58 ± 18 μg kg−1) at the time of incision. This group was matched with a selected control group that fulfilled all of the inclusion/exclusion criteria.
Patient characteristics, pre-operative PT, HCT, PLT and MELD were identical between groups. Prophylactic application of rFVIIA reduced packed red blood cells (3·9 ± 2·6 versus 6·9 ± 2·3 U, P = 0·01) and fresh-frozen plasma (FFP) (12·6 ± 6 versus 19·8 ± 7 U, P = 0·018) transfusion requirements when compared with the control group. FFP administration in the first 24 h after surgery was also significantly less in the rVIIa group when compared with the control group (388 ± 385 versus 1225 ± 701 mL, P = 0·003). Hospital stay following transplantation tended to be shorter in the rFVIIa group, albeit statistical significance was not achieved (11 ± 7·3 versus 7·9 ± 2·7, P = 0·2). All but one patient in the control group survived for 30 days after transplantation.
In a selected group of patients with prolonged PT and high MELD score, the prophylactic application of rFVIIa at the start of the OLT may reduce perioperative transfusion requirements.