VON WILLEBRAND FACTOR DYNAMICS AFTER RELATED LIVER TRANSPLANTATION

Аннотация

Liver transplant recipients have a high risk of bleeding and thrombosis due to hemostatic dysfunction. Standard coagulation tests are uninformative, key predictors are associated with blood loss and transfusions. Hypercoagulation is caused by inflammation, ischemia-reperfusion, platelet activation and metabolic disorders. MELD, hypothermia and acidosis increase the risk of bleeding, endothelial dysfunction and hemostatic imbalance - thrombosis and sepsis. New markers and approaches are needed to optimize the hemostatic strategy. Objective: to study markers of endothelial dysfunction and inflammation in connection with hemostatic parameters in liver transplant recipients with decompensated cirrhosis. Materials and methods: The study is registered (NCT06169592). Analysis of coagulogram and metabolic panel in 30 recipients (viral hepatitis B, D), average age 39.8±9.1 years. Groups by the presence of thrombohemorrhagic complications (THC). Fatal THC (hepatic artery thrombosis, venous thrombosis, bleeding) – in 5 patients, in 8 (27%) – conservative management. Results:The decrease in anticoagulants in recipients is more pronounced than in procoagulants: AT3 - 2.5 times, protein C - 1.9, plasminogen - 1.5, INR - 1.4, fibrinogen - 1.2 compared to the control. Endothelial dysfunction with an increase in the antigen and activity of von Willebrand factor was noted. In patients with an unfavorable outcome, the number of platelets was reduced before surgery (p < 0.05), but the liver panel and coagulogram parameters did not differ (p > 0.05). The dynamics of von Willebrand factor differed significantly between the groups, but the threshold value was not established (p > 0.05). Conclusions:The decrease in anticoagulants (AT3, protein C, plasminogen) in recipients is more pronounced than in procoagulants (INR, fibrinogen). In RTX recipients, coagulation factors (IIa) and anticoagulants (proteins C, S, AT-III) are reduced with a significantly (p<0.05) increased von Willebrand factor (VWF Ag, VWF Act).