Evaluation of hemostasis parameters in recipients following related transplantation of the right lobe of the liver

Abstract

Objective: to study the dynamics of hemostasis parameters in the early postoperative period and to identify the timing of restoration of the level of procoagulants and anticoagulants synthesized by the liver (received from a living related donor) in liver lobe recipients.Materials and methods. Under observation were 31 recipients and 31 related donors of liver lobe. They were treated at the Republican Specialized Scientific and Practical Medical Center for Surgery in Tashkent, Uzbekistan, from August 2022 to August 2023. Hemostasis parameters were determined in recipients, whose postoperative period was uneventful.Results. It was revealed that compensation in the hemostasis system occurs even at low levels of coagulation factors on day 10 after liver transplantation (LT). In recipients, a decrease in anticoagulants was more pronounced than that of procoagulants. In general, the hemostasis system was in an unstable equilibrium, which, under the influence of external and internal factors, can easily shift both towards hypercoagulable and hypocoagulable state. Activity of the fibrinolytic system and fibrinogen level are significant influencing factors. Gradual recovery of fibrinogen levels by the end of day 1 after surgery is the result of activation of the synthetic function of the liver. After LT, there were signs of endothelium activation, but not endothelial damage, which regress and normalize by postoperative day 10. At the same time, in the initial status, recipients had an increase in both the amount and activity of von Willebrand factor, which indicates endothelial damage and dysfunction. The low level of homocysteine in recipients is probably a protective factor against the development of thrombotic complications, and homocysteine dynamics reflects the gradual restoration of the functional activity of the liver, adaptation of the donor liver to functioning.Conclusion. Monitoring of hemostasis system in recipients after liver transplantation allows to prevent thrombohemorrhagic complications in time but also to assess the dynamic equilibrium of procoagulants and anticoagulants, the timing of restoration of the activity of the main hemostasis factors and, according to this, to vary the administration regimes of anticoagulants, antiplatelet medications, and fibrinolysis inhibitors, to carry out replacement therapy and to realize the concept of hemostasis management.