Liver Function and Transplantation

Liver Function and Transplantation: Coagulation Factors, Cardiovascular Changes, and Phases of Transplantation

Liver Function:

• The liver synthesizes most circulating coagulation proteins and plasma proteins.
• The procoagulant proteins (Factors II, VII, IX, X) are synthesized with the assistance of Vitamin K in the liver.
• Vitamin K is absorbed in the presence of bile in the small intestine.
• Anticoagulant proteins (Proteins S, C, Z, Fibrinolytic protein plasminogen, and Thrombopoietin) are dependent on Vitamin K.
• The liver does not produce Factors III, IV, VIII, tissue factor/thromboplastin & calcium, antihemophilic factor, or von Willebrand factor.
• Increased INR indicates liver dysfunction due to a lack of coagulation protein synthesis.
• Warfarin blocks the reduction of Vitamin K, which inhibits the creation of Vitamin K-dependent clotting factors.

Cardiovascular Changes in Cirrhosis:

• Relative hypovolemia and increased cardiac output.
• Hyperdynamic circulation results from portal HTN & cirrhosis causing local release of vasodilators.
• The cardiac resistance to sympathetic stimulation occurs via overproduction of vasodilators, resulting in a decreased response to vasoactive substances.
• Low arterial blood pressure, systolic incompetence, and diastolic dysfunction due to a hypertrophic septum and LV occur.
• Low SVR and increased HR occur.

Phases of Liver Transplantation & Physiologic Changes Associated:

Pre-Anhepatic Dissection:

• The main goal is to optimize volume status by achieving a balance of fluid perfusion & vasopressors.
• Acidosis & increased K+ can be corrected with loop diuretics, insulin & dextrose, bicarb, & hyperventilation.
• CaCl 1-2 g stabilizes the cardiac membrane from increased K+.
• Pressors/intropes are used to maintain hemodynamics.
• Coagulopathy is addressed by administering platelets & FFP.

Anhepatic Reperfusion/Neohepatic:

• The main issue faced is surgical bleeding.
• Volume loading is important due to decreased filling pressures when caval clamps are applied, and preload is significantly decreased when the portal vein and IVC are clamped.
• The decline in platelet and coagulation factors is due to no liver in “circulation.”
• The balance of volume and pressors is crucial for hemodynamic stability.
• Reperfusion syndrome may occur due to altered reperfusion from damaged endothelium.

Are you familiar with the crucial role that the liver plays in the body's coagulation system and cardiovascular function? Test your knowledge with this quiz on Liver Function and Transplantation. Learn about the synthesis of coagulation proteins, the impact of cirrhosis on cardiovascular changes, and the phases of liver transplantation and associated physiological changes. This quiz is a must-try for anyone interested in the intricacies of liver function and its impact on overall health.