Affiliation:
1. Russian Surgery Research Center Named after B. V. Petrovsky
2. Russian Surgery Research Center Named after B. V. Petrovsky; Sechenov First Moscow State Medical University (Sechenov University)
Abstract
The objective: to assess changes of clinical and laboratory hemostasic parameters in children at the stages of orthotopic liver transplantation.Subjects and Methods. A single-centre, prospective, pilot study of coagulation test scores was performed in 20 children aged 0 to 11 years with hepatoblastoma after a course of PRETEX IV chemotherapy who underwent liver transplantation from a related donor.Results. Children from 0 to 11 years old with hepatoblastoma, after chemotherapy, retain the normal functional activity of the hemostasis system at the pre-hepatic stage of transplantation: APTT 34.6 (34.45; 38.65) s; prothrombin index (PI) 83.53 (74.09; 87.87) %; INR 1.22 (1.16; 1.42) in the 0‒2 year group, APTT 40.45 (34.9; 41, 68), PI 75.57 (64.41; 80.45) %, and INR 1.39 (1.36; 1.87) in the group aged 3‒11 years. Severe hypocoagulation develops by the end of the hepatic stage and in the first 15 minutes after the start of arterial blood flow through the graft: CT and CFT from 195.0 (189.0; 228.5) s and 163.0 (129.5; 171.5) s to 537.0 (456.0; 1,651.5) s and 468.0 (324.5; 611.5) s (p < 0.05), respectively, in the INTEM test. Hypocoagulation at this time develops due to deficiency of coagulation factors and the release of endogenous glycosaminoglycans from the endothelium transplant, as indicated by an increase in CT and CFT to 666.0 (468.5; 2,209.5) s and 254.5 (203.25; 305.75) s in INTEM, CT to 525.0 (389.0; 2028.0) s with p < 0.05 in HEPTEM in children under the age group of up to 2. Within 1 hour after the start of arterial blood flow, the effects of systemic heparinoid effects persist, which is confirmed by the dynamics of CT 360.0 (219.5; 2,116.5) s with up to 960.0 (560.5; 1,440.5) s with p < 0.05 in the EXTEM test.Conclusion. Changes in hemostasis system parameters during surgery make it possible to judge about rapidly developing coagulation and anticoagulation disorders in children of the presented age groups. Specific changes in the coagulation profile at the stages of liver transplantation in children under the age of 11 inclusive, make it possible to do without routine correction of changes in the hemostasis system.
Publisher
FSBEI HE I.P. Pavlov SPbSMU MOH Russia
Subject
Anesthesiology and Pain Medicine,Critical Care and Intensive Care Medicine,Emergency Medicine
Reference31 articles.
1. Ventslovayte N.D., Efremova N.А., Goryacheva L.G. et al. Liver transplantation in children: the experience of last decades, current problems and solutions. Detskiye Infektsii, 2020, vol. 19, no. 2, pp. 52–56. (In Russ.) doi: 10.22627/2072-8107-2020-19-2-52-57.
2. Minov А.F., Dzyadzko А.M., Rummo O.O. Hemostatic disorders in liver diseases. Vestnik Transplantologii I Iskusstvennykh Organov, 2010, vol. 2, no. 12, pp. 82–91. (In Russ.) doi: 10.15825/1995-1191-2010-2-82-91.
3. Nosovskiy А.M., Pikhlak А.E., Logachev V.А. et al. Small sample statistics in medical research. Rossiyskiy Meditsinskiy Journal, 2013, no. 6, pp. 57-60. (In Russ.)
4. Timerbulatov Sh.V., Fayazov R.R., Smyr R.А. et al. Determination of volume and degree of acute blood loss. Meditsinsky Vestnik Bashkirostana, 2012, vol. 2, no. 7, pp. 69-72. (In Russ.)
5. Arnold K., Xu Y. E., Liao Y. et al. Synthetic anticoagulant heparan sulfate attenuates liver ischemia reperfusion injury. Scient. Rep., 2020, no. 1 (10), pp. 1-10. C. 17187. doi:10.1038/s41598-020-74275-7.