Coagulation plasma factor levels are early indicators of graft nonfunction following liver transplantation in children

Following liver transplantation, the decision to retransplant in cases in which graft function is marginal must be taken early. Plasma coagulation factor monitoring was evaluated as an early predictor of graft failure requiring retransplantation in the first posttransplant week. Plasma levels of fibrinogen, factors V, VII, VIII, IX, antithrombin III, protein C, and plasminogen were measured in all patients at 0, 12, 24, 48, 72, 96, and 120 hours posttransplant in 46 patients who received 56 grafts and results were compared between livers that failed early (group 1) and those that functioned adequately (group 2). Six grafts were included in group 1: one patient died before retransplantation, four were retransplanted once, and one patient was retransplanted twice. Three grafts had primary nonfunction (PNF), 2 had obstructed portal veins, and 1 had a long period of warm ischemia during the initial transplant. In group 1, plasma levels of factor V were significantly lower than in group 2 at 24, 48, and 72 hours posttransplant (21.2% ± 14.2%, 12.4% ± 4.5%, and 13.0% ± 5.0% v 39.1% ± 23.9%, 48.8% ± 31.9%, and 60.9% ± 25.9%; P < .05, P < .01, and P < .005, respectively). Similarly, plasma levels of factor VII were significantly lower in group 1 over the same period of time (7.3% ± 2.7%, 4.2% ± 1.8%, and 4.7% ± 2.5% v 27.4% ± 17.1%, 34.1% ± 21.6%, and 34.8% ± 18.6%, respectively; P < .005). Factor IX levels in group 1 grafts also were significantly lower than those in group 2, but only at 48 hours after transplantation (27.4% ± 12.5% v 54.1% ± 30.9%; P < .05). Regression analysis demonstrated a strong negative correlation between time after transplant and plasma levels of factors V, VII, and IX in group 1 grafts (r² = .841, .90, and .81, respectively), in contrast with the positive correlation with time after transplant and plasma factor V and IX levels in group 2 grafts (r² = .964 and .749, respectively). Plasma levels of fibrinogen, plasminogen, factor VIII, protein C, and antithrombin III were not helpful in predicting those grafts that required early retransplantation. We conclude that factor V, VII, and IX levels immediately after liver transplantation are the best predictors of ultimate graft function and may be the earliest indicators of the need for retransplantation.