Improved early graft survival in patients receiving aprotinin during orthotopic liver transplantation

REPERFUSION injury contributes to hepatic dysfunc- tion and may play a role in the initiation of acute and chronic rejection after orthotopic liver transplantation (OLT). Injury that occurs during reperfusion has been described as an injury of the sinusoidal endothelial cells (SEC). Proteolytic enzymes, such as cysteine- and serine- proteases and matrix metalloproteinases, have been shown to play a role in this process.1 Aprotinin is an inhibitor of serine-proteases and has wide-acting, antiproteolytic prop- erties. In the European Multicenter Study on the Use of Aprotinin in Liver Transplantation (EMSALT) we recently showed that aprotinin significantly reduces hyperfibrinoly- sis, thereby reducing blood loss and transfusion require- ments during OLT by 50% and 30%, respectively.2 Besides its blood-sparing effect it has been suggested that aprotinin ameliorates reperfusion injury. Based on these properties, we studied early graft function after OLT in patients who received aprotinin or placebo during transplantation.