Thrombin-activatable Fibrinolysis Inhibitor (TAFI) as a Novel Prognostic Factor After Orthotropic Liver Transplantation: A Pilot Study

Background. Thrombin-activatable fibrinolysis inhibitor (TAFT), a liver-produced coagulation factor, has been associated with higher mortality in cirrhotic patients, but there has not been any description of its role in perioperative care in liver transplantation cases. Methods. A total of 21 patients were included. Serum TAFT levels were determined at 3 time points: preoperatively (TAFT pre), immediately postoperative (TAFI PO), and 24 hours postoperatively (TAFI 24 h). The main outcome was the physiological pattern of TAFI in the perioperative period of liver transplantation. The secondary outcomes were the association between TAFI and early allograft dysfunction (EAD) as well as that of TAFI and 6-month mortality. Results. TAFI levels increased at the 24-hour time point, compared to the other 2 time points (TAFI pre, P = .007; TAFT PO, P = .0001). Early allograft dysfunction occurred in 2 of 21 patients, both demonstrating lower TAFT 24 h levels compared to those who did not develop this complication (3.0 +/- 0.2 vs 1.5 +/- 0.3; P = .0001). Three patients who died all demonstrated lower levels of TAFT pre (1.3 +/- 0.1 vs 2.5 +/- 0.5; P = .001) and TAFI PO (1.2 +/- 0.1 vs 2.4 +/- 0.4; P = .001) compared to the survivors. Conclusions. These findings suggest that the determination of TAFI levels-both pre- and postoperatively may be of clinical relevance in liver transplant recipients.