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Haemorrhage as a Complication of Extracorporeal Pig Liver Perfusion: Studies on Mechanism and Prevention

Br Med J 1972; 2 doi: https://doi.org/10.1136/bmj.2.5816.735 (Published 24 June 1972) Cite this as: Br Med J 1972;2:735

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  1. John Winch,
  2. J. Kolthammer,
  3. R. Hague,
  4. R. Fleisher,
  5. K. B. Shilkin,
  6. Roger Williams

    Abstract

    The use of extracorporeal pig liver perfusion for temporary liver support has been followed not infrequently by major bleeding with a fall in coagulation factors and platelets, rather than a rise as hoped. In 18 experimental perfusions in which 125I-labelled fibrinogen was used as a marker there was in every instance a significant loss of the fibrinogen into the fluid supporting the liver in the perfusion chamber. Further, in 11 of the perfusions there was an additional loss into liver substance, this being associated with a very rapid fall in 125I fibrinogen and platelets content of the perfusion fluid. Damage to the sinusoids from ischaemic damage incurred during removal of the liver could explain both the direct loss of fibrinogen and, as a result of intravascular coagulation, the associated loss within the perfused liver. No correlation could be found with biochemical function, but it proved possible to assess haematological safety before connexion of the patient to the perfusion by a shortened 125I fibrinogen test. This was done in three patients treated by five perfusions and in none was the thrombocytopenia or coagulation disturbance adversely affected.