Cause of Abnormal Bleeding After Transplantation of Pig Liver Stored by a Perfusion Technique

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Abstract
Ten of 12 pigs transplanted with livers stored in a perfusion device for 24 hours died within 12 hours because of uncontrollable bleeding. Recipients of fresh livers or of livers stored for eight to ten hours survived until the liver was rejected. Uncontrollable bleeding correlated with dramatic falls in the recipient's platelet count. Levels of clotting factors I (fibrinogen), II (prothrombin), and VIII (antihemophilic factor) were also reduced. Activation of fibrinolysis was comparatively minimal. The observed changes are those expected with extensive intravascular coagulation. Evidence has been presented elsewhere that the endothelial lining of liver sinusoids was destroyed by prolonged perfusion storage. This correlated with and appears to be a reasonable basis for activation of intravascular coagulation.