Coagulability and fibrinolytic changes during veno-venous bypass in liver transplantation.

In clinical liver transplantation, a venous bypass that rechannels the blood flow from the inferior vena cava and portal vein to the superior vena cava has been used to maintain the venous return. However, the usage of mechanical shunt has given rise to derangements of blood coagulability and fibrinolysis. Therefore, changes of coagulability and fibrinolysis during the venous bypass were examined in dogs using a centrifugal pump (Bio-Pump), and the effect of gabexate mesilate for coagulation were studied. Venous bypass from the inferior vena cava and the portal vein to the external jugular vein was performed in mongrel dogs (group A: bypass without pump, group B: bypass with the Bio-Pump, group C: bypass with the Bio-Pump and the addition of gabexate mesilate). In group A, blood pressure gradually decreased, but in groups B and C it maintained the pre-bypass level. All results of coagulation parameters and fibrinolytic measurements of group B were not significantly different from those of group A; only partial thromboplastin time was prolonged in group B. However, this prolongation was effectively prevented by the addition of gabexate mesilate in group C.