TY - JOUR
T1 - Aminocaproic acid (Amicar) as an alternative to aprotinin (Trasylol) in liver transplantation
AU - Mangus, R. S.
AU - Kinsella, S. B.
AU - Fridell, J. A.
AU - Kubal, C. A.
AU - Lahsaei, P.
AU - Mark, L. O.
AU - Tector, A. J.
N1 - Funding Information:
Drs. Mangus has received funding from the ROCHE Organ Transplant Research Fund, and Dr. Kinsella has received Indiana University School of Medicine institutional funding. The other authors have indicated they have no financial relationships relevant to this article to disclose.
PY - 2014/6
Y1 - 2014/6
N2 - Introduction This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period. Patients and Methods Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent. Results Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28%]), high-dose aprotinin (n = 308 [26%]), EACA (n = 216 [18%]), or no antifibrinolytic (n = 322 [28%]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA. Conclusions These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.
AB - Introduction This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period. Patients and Methods Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent. Results Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28%]), high-dose aprotinin (n = 308 [26%]), EACA (n = 216 [18%]), or no antifibrinolytic (n = 322 [28%]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA. Conclusions These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.
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U2 - 10.1016/j.transproceed.2014.04.006
DO - 10.1016/j.transproceed.2014.04.006
M3 - Article
C2 - 24935303
AN - SCOPUS:84902437853
SN - 0041-1345
VL - 46
SP - 1393
EP - 1399
JO - Transplantation proceedings
JF - Transplantation proceedings
IS - 5
ER -