Antiphospholipid antibodies before and after liver transplantation.

OBJECTIVE: The aim of this study was to determine whether liver transplantation of patients with antiphospholipid antibodies (APA) is 1) adversely affected with vascular thrombosis and 2) whether such antibodies persist post transplantation. METHODS: Twelve patients with APA awaiting transplant were identified and characterized biochemically and immunologically. Each had the level of APA determined using commercially available enzyme-linked immunoassay kits before, during, and after liver transplantation. RESULTS: No patient in this series experienced a transplant-related vascular thrombosis. The titer of APA fell to levels at or below those present in normals and remained low in two of 12 or undetectable in 10 of 12 patients 1 yr after liver transplantation. CONCLUSIONS: We reached the following conclusions: 1) Antiphospholipid positivity does not identify patients at high risk for post-transplant vascular thrombosis. 2) The levels of antiphospholipid present in sera pretransplant fell during transplantation and remained low or undetectable 1 month and 1 yr post transplantation.

Hemostatic modulation with the liver dialysis device in humans with advanced liver disease.

BACKGROUND/AIMS: To determine the alterations in coagulation and fibrinolysis occurring in patients treated with the liver dialysis device. METHODOLOGY: Patients with advanced liver disease treated with the liver dialysis device were studied immediately before and after the liver dialysis device treatment. SETTING: A university hospital intensive care unit. PATIENTS: Thirteen consecutive patients with advanced liver disease being evaluated for or awaiting liver transplantation. INTERVENTION: 4-6 hours of liver dialysis treatment for management of hepatic encephalopathy. OUTCOME MEASURES: A panel of coagulation and anticoagulation factors, as well as fibrinolytic and anti-fibrinolytic factors plus measures of activation of inflammation and soluble adhesion factors. RESULTS: The liver dialysis device used was found to be associated with activation of both coagulation and fibrinolytic pathways, activation of inflammation reactants, and an increase in sL-selectin levels. CONCLUSIONS: Liver dialysis device activates both coagulant and fibrinolytic pathways, activates inflammatory response, but these responses are limited to the vascular compartment by an increase in sL-selectin levels.