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The significance of heparin-coated veno-venous bypass circuits in liver transplantation

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Rigmor Solberg

Department of Pharmacology, School of Pharmacy, Blindern, University of Oslo, Oslo N-1068, Norway

Cecilie Okkenhaug

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Vibeke Videm

Department of Immunology and Transfusion Medicine, Institute of Laboratory Medicine, The Regional Hospital, Norwegian Institute for Science and Technology, Trondheim, Norway

Michael J Gallimore

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Øystein Mathisen

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Tom E Mollnes

Department of Immunology and Transfusion Medicine, Nordland Central Hospital, Bodø, Norway and University of Tromsø, Norway

Anstein Bergan

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Odd Søreide

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

Göran B Klintmalm

Transplantation Services, Department of Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA

Ansgar O Aasen

Institute for Surgical Research and Surgical Department, Rikshospitalet-National Hospital, Oslo N-0027, Norway

We studied the effects of veno-venous bypass (VVBP) circuit surface heparinization on the activation of the plasma defence systems (coagulation, fibrinolysis, kallikrein-kinin and complement) and leukocyte activation in a prospective randomized study in 20 patients during and 1 day after liver transplantation (OLT). To our knowledge, this is the first study of this kind where the possible benefits of surface heparinization of the VVBP circuit in OLT have been investigated. Twenty patients were randomized to either heparin-coated (HC) VVBP equipment or to otherwise identical noncoated (NC) circuits. Five blood samples were drawn during the OLT procedure: one just before VVBP, three during VVBP and one 5 min after portal venous reperfusion (PVR). A further sample was taken 1 day after the operation. Components of the blood coagulation, fibrinolytic and kallikrein-kinin systems were analysed using functional assays (chromogenic peptide substrate assays) or enzyme immunoassays (EIA). Complement system factors and granulocyte activation, represented by myeloperoxidase (MPO) release, were analyzed by EIA. Activation of the plasma defence systems occurred in both groups at an early stage during OLT and a further activation occurred 5 min after PVR. MPO levels were slightly elevated 5 min after PVR. However, no significant differences between the two groups were observed. Significant activation of the humoral defense systems was found in both groups during OLT. A considerably larger study, including at least 330 patients, is necessary to fully assess the possible benefits of surface heparinization of the VVBP circuit.

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