ABSTRACT
This chapter provides an overview of the bleeding problems and the underlying mechanisms in liver transplantation and to discuss the role of hyperfibrinolysis in more detail. Liver transplantation differs from other major surgical procedures, among others in the amount of intraoperative blood loss. Well-organized blood bank support is essential for a successful liver transplantation program. Several explanations for the increased fibrinolytic activity were sought. Some investigators found disseminated intravascular coagulation (DIC) to be the most important factor in the derangement of hemostasis and explained hyperfibrinolysis as secondary to DIC. The central protein of the extrinsic fibrinolytic system is tissue-type plasminogen activator (t-PA). Endothelial cells are the main source of t-PA, which is probably the plasminogen activator that can be recruited most rapidly and is most active in the circulation. Apart from the t-PA-mediated extrinsic fibrinolytic system there are other ways of fibrinolytic activation by different plasminogen activators that are present in the circulation.
