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INTRODUCTION: Thrombotic complications after liver transplantation limit the long-term success of the procedure. Therefore, an early and accurate diagnosis with the appropriate treatment is crucial to sustain the proper functioning of the graft. AIM: To evaluate the return of newly transplanted liver function within the first days of ICU stay after liver transplantation surgery (Ltx) observed in laboratory examination. It is important to understand the physiology of the newly transplanted liver, particularly in terms of its metabolic function and the assessment of easy-to-monitor coagulation parameters and enzyme markers. MATERIAL AND METHODS: We present our observations carried out in 27 patients, transplanted in the period 2015-2017, during their stay in the Department of Anaesthesiology and Intensive Therapy of the University Hospital in Wroclaw. We demonstrated changes in laboratory parameters within 72 h after liver transplantation and the concept of anticoagulant therapy at our institution. RESULTS: The presented results show the characteristics of aspartate transaminase, alanine transaminase, bilirubin, and standard tests evaluating the coagulation system within the first 4 days after surgery. The concept of anticoagulant therapy used in our intensive care unit is also presented. The aim of the work is an observation of physiology of the graft function in the aspect of coagulation disorders. CONCLUSIONS: The early postoperative period is considered prognostic. The characteristics of basic biochemical tests are determined by the function of the transplanted organ. Implementation of anticoagulant therapy in this period is a therapeutic challenge that requires experience.
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BACKGROUND: As the incidence of cardiovascular diseases increases, the use of antiplatelet therapy is widely recognized. This presents clinicians with the challenge of balancing the risk of thrombotic and bleeding complications. Platelet dysfunction is one of the causes of postoperative bleedings and their etiology is not fully understood. Platelets receptors point-of-care investigation is of a remarkable value in assessing patients risk of bleeding. Reliable assessment of platelet function can improve treatment. The aim of this study was to evaluate the activity of platelet receptors in patients qualified for cardiac surgery, taking into account organ dysfunctions and pharmacological therapy applied in these patients. METHODS: Seventy-one cardiac surgical patients were analyzed before surgery using multiple electrode aggregometry with the use of the ADP test and ASPI test. The cut-off values were determined based on the manufacturer's recommendations. Patients were divided into four groups: Group I (33/71 patients, without platelet dysfunctions), Group II (6/71 patients, ADP < 710 AU x min), Group III (13/71 patients, ASPI < 570 AU x min) and Group IV (19 / 71 patients, ADP < 710 AU x min and ASPI < 570 AU x min). Biochemical data defining the efficiency of the liver and kidneys, the list of preoperative drugs used and the requirement for transfusion throughout the study group were collected. RESULTS: The study group included 41 males (57.7%) and 30 females (42.3%), mean age 66 years. The majority of patients (94.4%) had platelet counts within the normal range, but platelet function was impaired in more than half of the studied patients (53.5%). No relationship was found between the biochemical markers of the kidneys and liver and the function of the ADP and ASPI receptors, while receptors activities were related (rs = 0.72, p < 0.001), and both associated with platelet count (rs = 0.55, p < 0.001 and rs = 0.42, p < 0.001, respectively). Platelet receptors activity was not related to the postoperative need for any type of transfusion as well as the applied preoperative pharmacological therapy. CONCLUSIONS: Early identification of patients at high risk of bleeding, using point-of-care platelet function assessment tests, enables a targeted therapeutic pathway. Due to the variety of factors affecting the activity of platelets, finding a specific cause of this pathology is extremely difficult. According to our study, the correlation between platelet receptor disorders and mild to moderate liver and kidney injury has not been demonstrated. However, platelet receptors dysfunction has been shown to be associated with a decreased number of platelets.