Fibrinolysis During Liver Transplant and Use of Solvent/Detergent Virus-Inactivated Plasma (ESDEP??/Octaplas??)

To the Editor: We have with interest read the retrospective observational study by de Jonge et al. (1) of enhanced fibrinolysis during liver transplantation after use of solvent/detergent virus inactivated (SD) plasma. As the authors state, the production method for ESDEP®/Octaplas® (Octa- pharma, Vienna, Austria) reduces the content of α2-antiplasmin by up to 76%(2–6). α2-antiplasmin is a liver synthesized acute-phase serine protease inhibitor of plasmin (7). Following a decision by our Surgeon General in 1992, SD plasma has totally replaced FFP in Norway since 1993. Since then, more than 250,000 units of Octaplas® have been transfused. So far the product has been used in all types of patients, including neonates. No particular problems with fibrinolysis have been reported after Octaplas® transfusion, however, the serine protease inhibitor Aprotinin, is generally used in patients with severe liver failure (including liver transplantation) and in complicated repeat cardiac surgery. Allogeneic transplant surgery in Norway is centralized to our hospital. We have performed 208 liver transplants between 1993-2001 using Octaplas® without particular problems with fibrinolysis. Thus the Norwegian experience with Octaplas® does not support the suggestion by de Jonge et al. for routine administration of antifibrinolytic drugs when using SD plasma produced by Octapharma. Bjarte G. Solheim, MD, PhD Anstein Bergan, MD, PhD Frank Brosstad, MD, PhD Robert Innes, MD, PhD Jan L. Svennevig, MD, PhD