Six intraoperative blood samples were obtained at intervals from each of 100 individuals undergoing their first liver transplants. The patients fell into the following diagnostic categories: postnecrotic cirrhosis 28, primary biliary cirrhosis 20, sclerosing cholangitis 19, miscellaneous diseases 14, carcinoma/neoplasia 12 and fulminant hepatitis 7. Coagulation factor values in the initial (baseline) blood samples varied by patient diagnosis. In general, all factor levels were reduced except factor VIII:C, which was increased to almost twice normal. The slight intraoperative changes in factors 11, VII, IX, X, XI and XI1 suggested that a steady-state relationship existed between depletion (consumption/bleeding) and repletion (transfusion, transit from extra-to intravascular space), even in the anhepatic state. In contrast, there were rapid and very significant falls in factor VIII and fibrinogen and a less pronounced decrease in factor V, all reaching their nadirs in early to mid-Stage 111. The cause of these coagulation changes appears to be activation of the f'ibrinolytic system.
Liver transplantation has been used t o treat end-stage liver disease caused by a wide variety of congenital or acquired disorders. Improved methods for procurement