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Blutungen in der Transplantationschirurgie

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Lebensbedrohliche Gerinnungsstörungen in der Intensivmedizin

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Zusammenfassung

Blutungskomplikationen in der Transplantationschirurgie resultieren einerseits aus der Komplexität des operativen Eingriffs und andererseits aus spezifischen Veränderungen der Hämostase aufgrund des zugrundeliegenden Organdefektes. So ist bei fehlenden sekundären Organschäden das Blutungsrisiko der Herztransplantation nicht wesentlich unterschiedlich von dem der koronaren Bypasschirurgie. Der infolge einer dekompensierenden Herzinsuffizienz mit konsekutivem Multiorganversagen resultierende Hämostasedefekt — unter Umständen agraviert durch den passageren kontinuierlichen Extrakorporalkreislauf eines Kunstherzens („bridging“) mit Antikoagulation — vervielfacht das Blutungsrisiko der folgenden Transplantation. Während hier das Verständnis der Pathophysiologie und die sich daraus ableitenden Möglichkeiten der therapeutischen Intervention in den Anfängen steckt, sind die Verhältnisse bei der Lebertransplantation weitgehend verstanden. Als weiteres Beispiel kann die Knochenmarktransplantation dienen, deren Grundlagen wesentlich von denen der Transplantation solider Organe abweicht.

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Literatur

  1. Atkinson K, Norrie S, Chan P, Zehnwirth B, Downs K, Biggs J (1986) Hematopoietic progenitor cell function after HLA-identical sibbling bone marrow transplantation: Influence of chronic graft-versus-host disease. Int J Cell Cloning 4: 203

    Google Scholar 

  2. Baglin TP, Harper P, Marcus RE (1990) Venoocclusive disease of the liver complicating ABMT successfully treated with recombinant tissue plasminogen activator (rt-PA). Bone Marrow Transplan 5A39–441

    Google Scholar 

  3. Bechstein WO, Riess H, Neuhaus P, Himmelreich G, Steffen R, Slama KJ, Rossaint R, Blumhardt G (1991) The effect of aprotinin on blood product requirements during orthotopic liver transplantation. Clin Transplant 5: 422–426

    Google Scholar 

  4. Böhming HJ (1977) The coagulation disorder of orthotopic hepatic transplantation. Semin Thromb Hemostasis 4: 57–82

    Google Scholar 

  5. Col-De Beys C, Carlier M, Reynaert M, Lavenne-Pardonge E, Legrand-Monsieur A, Otte J-B, Moriau M (1991) Prediction of bleeding during orthotopic liver transplantation in recipients given tranexamic acid. Thromb Haemostas 65: 1088 (Abstract]

    Google Scholar 

  6. Devergie A, Scrobohaci ML, Drouet L, Vilmer E, Gluckman E (1986) Changes in endothelial and coagulation parameters after allogeneic bone marrow transplant (BMT) as a mean of prediction of veinoocclusive disease (VOD). Exp Haematol 14: 430 [Abstract]

    Google Scholar 

  7. Dzik WH, Arkin CF, Jenkins RL, Stump DC (1988) Fibrinolysis during liver transplantation in humans. Role of tissue-type plasminogen activator. Blood 71: 1090–1095

    Google Scholar 

  8. First LR, Smith BR, Lipton J, Nathan DG, Parkuran R, Rappeport JM (1985) Isolated thrombocytopenia after allogenic bone marrow transplantation: Existence of transient and chronic thrombocytopenic syndromes. Blood 665: 368–374

    Google Scholar 

  9. Groh J, Welte M, Azad SC, Forst H, Pratschke E, Kratzer MAA (1992) Does aprotinin affect blood loss in liver transplantation? Lancet 340: 173

    Article  PubMed  CAS  Google Scholar 

  10. Grosse H, Lobbes W, Frambach M, von Broen O, Ringe B, Barthels M (1991) The use of high dose aprotinin in liver transplantations. The influence on fibrinolysis and blood loss. Tromb Res 63: 287–297

    Google Scholar 

  11. Groth CG, Pechet L, Starzl TE (1969) Coagulation during and after orthotopic transplantation of the human liver. Arch Surg 98: 31–34

    Article  PubMed  CAS  Google Scholar 

  12. Harper PL, Luddington RI, Jennings L, Reardon D, Seaman MJ, Carrell RW, Klinik JR, Smith M, Rolles K, Caine R (1989) Coagulation changes following hepatic revascularisation during liver transplantation. Transplantation 48: 603–607

    PubMed  CAS  Google Scholar 

  13. Harper PL, Jarvis J, Jennings I, Luddington R, Marcus RE (1990) Changes in the natural anticoagulants following bone marrow transplantation. Bone Marrow Transplan 5: 39–42

    CAS  Google Scholar 

  14. Himmelreich G, Riess H (1991) In vitro inhibition of platelet aggregation by the liver preservation fluid UW solution. Transplantation 52: 30–33

    Article  PubMed  CAS  Google Scholar 

  15. Himmelreich G, Kierzek B, Neuhaus P, Slama K-J, Riess H(1991) Coagulation changes and the influence of the early perfusate in the course of orthotopic liver transplantation (OLT) when aprotinin is used intraoperatively. Blood Coagul Fibrinol 2: 51–59

    Google Scholar 

  16. Himmelreich G, Muser M, Steffen R, Bechstein WO, Slama K-J, Jochum M, Riess H (im Druck) Different aprotinin applications influencing hemostatic changes in orthotopic liver transplantation (OLT). Transplantation

    Google Scholar 

  17. Himmelreich G, Hundt K, Neuhaus P, Roissant R, Riess H (im Druck) Prostaglandine El infusion intraoperatively is reducing impaired platelet aggregation after reperfusion in orthotopic liver transplantation. Transplantation

    Google Scholar 

  18. Holler E, Kolb HJ, Müller A, Kempeni S, Liesenfeld S, Pechumer H, Lehmacher W, Ruckdeschel W, Gleixner B, Riedner C, Ledderose G, Brehm G, Mittermller J, Wilmanns W (1990) Increased serum levels of tumor necrosis factor o precede major complications of bone marrow transplantation. Blood 75: 1011–1016

    PubMed  CAS  Google Scholar 

  19. Ickx et al. (1993) Effect of two different dosages of aprotonin on perioperative blood loss during liver transplantation. Semin Thromb Hemostasis Volume 19, No. 3, 300–301

    Article  CAS  Google Scholar 

  20. Duckett M, Perry EH, Daniels BS, Weisdorf DJ (1991) Hemolytic uremic syndrome following bone marrow transplantation. Bone Marrow Transplant 7: 405–409

    Google Scholar 

  21. Kang YG, Lewis JH, Navalgund A, Russell MW, Bontempo FA, Niren LS, Starzl TE (1987) Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation. Anesthesiology 66: 766–773

    Article  PubMed  CAS  Google Scholar 

  22. Kaufmann PA, Jones RB, Greenberg CS, Peters WP (1990) Autologous bone marrow transplantation and factor XII, factor VII, and protein C deficiencies. Cancer 66: 515–521

    Article  Google Scholar 

  23. Le Querrec A, Derlon A, Deshayes JP, Tartiere J, Segol P, Bricard H, Thomas M (1991) Effect of aprotinin on fibrinolysis during orthotopic liver transplantation: a preliminary study. Thromb Haemostas 65: 1089 [Abstract]

    Google Scholar 

  24. Mallet SV, Cox D, Burroughs AK, Rolles K (1991) The intra-operative use of Trasylol (aprotinin) in liver transplantation. Transplant Int 4: 227–230

    Google Scholar 

  25. Minchinton RM, Waters AH (1985) Autoimmune thrombocytopenia and neutropenia after marrow transplantation. Blood 66: 752 [Letter]

    Google Scholar 

  26. Neuhaus P, Bechstein WO, Lefebre B, Blumhardt G, Slama K (1988) Effect of aprotinin on intraoperative bleeding and fibrinolysis in liver transplantation. Lancet 1I: 1924. 14

    Google Scholar 

  27. Panella TJ, Peters W, White JG, Hannun YA, Greenberg CS (1990) Platelets acquire a secretion defect after high-dose chemotherapy. Cancer 65: 1711–1716

    Article  PubMed  CAS  Google Scholar 

  28. Panzer S, Kiefel V, Bartram CR, Haas OA, Hinterberger W, Mueller-Eckardt C, Lechner K (1989) Immune thrombocytopenia more than a year after allogeneic bone marrow transplantation due to antibodies against donor platelets with anti-P1A1 specificity: evidence for a host-derived immune reaction. Br J Hematol 71: 259–264

    Article  CAS  Google Scholar 

  29. Porte RJ, Knot EAR, Bontempo FA (1989) Hemostasis in liver transplantation: a review. Ggastroenterology 97: 488–501

    CAS  Google Scholar 

  30. Riess H (1995) The use of aprotinin in liver transplantation. In Pifarre R (ed) Blood conservation with aprotinin Hanley & Belfus, Philadelphia pp 349–358

    Google Scholar 

  31. Riess H, Jochum M, Machleidt W, Himmelreich G, Roissaint R, Steffen R (1991) Possible role of extracellularly released phagocyte proteinases in the coagulation disorder during liver transplantation. Transplantation 52: 482–490

    Article  PubMed  CAS  Google Scholar 

  32. Riess H, Jochum M, Machleidt W, Himmelreich G, Muser M, Huhn D (1991) Tumor necrosis factor: possible role in the disorder of hemostasis during liver transplantation. Thromb Haemostas 65: 1091 [Abstract]

    Google Scholar 

  33. Smith RE, Berg DD (1988) Coagulation defects in cyclosporine A treated allogeneic bone marrow transplant patients. Am J Hematol 28: 137–140

    Article  PubMed  CAS  Google Scholar 

  34. Suarez et al. (1993) Effectiveness of aprotonin in orthotopic liver transplantation. Semin Thromb Hemostasis Volume 19, No. 3, 292–296

    Article  CAS  Google Scholar 

  35. Tschuchnigg M, Bradstock KF, Koutts J, Stewart J, Enno A, Seldon M (1990) A case of thrombotic thrombocytopenic purpura following bone marrow transplantation. Bone Marrow Transplant5: 61–63

    Google Scholar 

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  1. H. Riess
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Editors and Affiliations

  1. William-Harvey-Klink, Abt. für Innere Medizin, Am Kaiserberg 6, D-61231, Bad Nauheim, Deutschland

    Viola Hach-Wunderle

  2. Medizinische Klinik I, Universität Heidelberg, Bergheimer Straße 58, D-69115, Heidelberg, Deutschland

    Peter P. Nawroth

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© 1996 Springer-Verlag Berlin Heidelberg

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Riess, H. (1996). Blutungen in der Transplantationschirurgie. In: Hach-Wunderle, V., Nawroth, P.P. (eds) Lebensbedrohliche Gerinnungsstörungen in der Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-12220-4_6

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  • DOI: https://doi.org/10.1007/978-3-662-12220-4_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-60367-2

  • Online ISBN: 978-3-662-12220-4

  • eBook Packages: Springer Book Archive

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