Packing procedure effective for liver transplantation in hemophilic patients with HIV/HCV coinfection
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Packing procedure effective for liver transplantation in hemophilic patients with HIV/HCV coinfection Susumu Eguchi1 · Akihiko Soyama1 · Takanobu Hara1 · Masaaki Hidaka1 · Shinichiro Ono1 · Tomohiko Adachi1 · Takashi Hamada1 · Tota Kugiyama1 · Sinichiro Ito1 · Kengo Kanetaka1 · Takuji Maekawa2 · Motohiro Sekino3 · Tetsuya Hara2,3 · Kazuhiro Nagai4 · Yasushi Miyazaki4,5 Received: 7 January 2020 / Accepted: 17 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract We herein report an effective procedure for liver transplantation (LT) for severe cirrhotic patients with hemophilia. Three hemophilic patients suffering from liver cirrhosis due to human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection underwent deceased donor LT in our institute. Basic clotting parameters were measured and evaluated during LT to determine the optimal packing procedure. All patients were treated with a gauze packing procedure to ensure stable hemostasis in relation to hemophilia during the peri-transplant period. The graft function of all patients recovered well upon gauze removal (depacking) procedure and the patients were finally discharged to home. The administration of clotting factor was discontinued on day 3 after deceased donor LT. No infectious complications occurred in any of the 3 patients. This technique could be an option for achieving successful LT in these patients. Cooperation between transplant surgeons and anesthesiologists can make this challenging operation possible. Keywords Packing · Hemophilia · Liver transplantation
Introduction In Japan, 90% of the patients who were infected with human immunodeficiency virus (HIV) due to exposure to contaminated blood products used in the management of hemophilia in the 1980s were coinfected with hepatitis C virus (HCV) [1]. These patients rapidly developed cirrhosis and require liver transplantation (LT) [2], which is complicated to perform since hemostasis is very difficult to control during and
* Susumu Eguchi sueguchi@nagasaki‑u.ac.jp 1
after LT, in addition to complications associated with their infections,. Recently, the results of LT for patients with hemophilia have been published, indicating that the complication rate—especially bleeding complications—was higher in hemophilic patients, while the overall survival rate was the same as that in patients without hemophilia [3]. Thus, for hemophilic patients, meticulous hemostasis and planning for bleeding control is very important for successful LT. An intentional gauze packing procedure has been advocated in cases of acute care surgery and for trauma patients with massive bleeding as a result of clotting disorder [4]. We have used such a procedure for LT in cirrhotic hemophilic patients. We herein report our gauze packing strategy, which was applied in the treatment of 3 hemophilic patients with HIV/HCV co-infection.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
2
Department of Anesthesiology, Nagasaki University Graduate Sch
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