Recombinant FVII in orthotopic liver transplantation (OLT): a preliminary single centre experience

Excerpt

Sir: As recently assessed by Key [1], the decision on when and where to use rFVIIa for patients with uncontrolled bleeding or in clinical settings in which massive bleeding could be a risk, continues to be a matter of discussion. It seems questions greatly exceed definite answers. In cirrhotic patients, intraoperative blood loss could become critical during major surgery and particularly during orthotopic liver transplantation (OLT): massive blood loss and large transfusion requirements are correlated with increased morbidity and mortality [2]. Innovative preservation solutions and refinements in surgical and anaesthetic techniques have reduced blood losses and transfusion needs during surgery. In this setting, a critical role has been played by the appropriate supplementation of blood products, by the use of antifibrinolytic drugs [3] and, in cases of excessive heparinisation during organ harvesting, by the judicious use of protamine [2]. Recently, the use of recombinant factor VIIa (rFVIIa, NovoSeven, NovoNordisk) has been reported during OLT by Hendricks et al. in six adults (80 µg/kg at the start of operation) [4] and by M. Hart in 14 patients (American Society Hematology, 2002, unpublished data, 20 µg/kg at the start of surgery) as a measure able to reduce blood loss and transfusion needs significantly when compared to matched historical controls. …