Effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation

Objective To evaluate the effect of ulinastatin on coagulation function in patients undergoing orthotopic liver transplantation (OLT). Methods Twenty ASA Ⅲ or Ⅳ patients with end-stage liver diseases undergoing OLT, aged 36-59 yr, were randomly divided into 2 groups (n = 10 each): control group (group C) and ulinastatin group (group U). Group U received iv infusion of ulinastatin 2 × 104 U/min for 1 h (ulinastatin 12 × 105 U in 400 ml normal saline) after skin incision and repeated every 4 h. Group C received the same volume of normal saline instead of ulinastatin. Anesthesia was induced with midazolam 0.05-0.1 mg/kg, etomidate 0.3 mg/kg, fentanyl 5 μg/kg, and vecuroninm 0.1 mg/kg and maintained with isoflurane inhalation (end-tidal concentration 0.3%-0.6%) and intermittent iv boluses of feutanyl 2-3 μg/kg and vecuronium 0.5 mg/kg and iv phase, 30 min of anbepatic phase, 30 min of neohepatic phase for determination of Sonoclot and routine coagulation function and plasma Ca2+ concentration. Blood loss and transfusion volume during operation, and 24-h drainage flow after operation were recorded. Results Compared with the values before skin incision, thrombin time, prothrombin time, activated partial thromboplastin time, activated clotting time were prelonged, and concentrations of fibrinogen and plasma Ca2+, fibrinogen clotting rate and platelet function decreased in both groups, and D-direct concentration was significantly increased in group C (P 0.05). Conclusion Intravenous infusion of ulinastatin during operation can improve coagulation function and reduce postoperative blood loss in patients undergoing OLT. Key words: Trypsin inhibitors; Liver transplantation; Blood coagulation tests