ON MARCH 1, 1963, orthotopic liver homotransplantation was performed in a 3-year-old child with congenital biliary atresia. Immediately after revascularization of the hepatic homograft, uncontrollable bleeding developed which resulted in death a few hours later. Blood studies obtained at the time of the hemorrhagic crisis revealed an exceedingly sharp increase of plasma fibrinolytic activity, as well as hypofibrinogenemia.
As a result of this experience, laboratory investigations were undertaken to define with more predictability the changes in coagulation to be expected during and after canine hepatic homografting procedures. In addition, a collateral study of fibrinolytic activity was carried out in dogs subjected to total hepatectomy without homotransplantation.
Finally, the opportunity eventually became available to study some aspects of the clotting process in four additional patients who received whole-organ hepatic homografts after removal of their diseased livers. From this composite laboratory and clinical experience, a clear idea has emerged concerning the coagulation
von KAULLA KN, KAYE H, von KAULLA E, MARCHIORO TL, STARZL TE. Changes in Blood CoagulationBefore and After Hepatectomy or Transplantation in Dogs and Man. Arch Surg. 1966;92(1):71-79. doi:10.1001/archsurg.1966.01320190073016