The hemostatic status of pediatric recipients of adult liver grafts suggests that plasma levels of hemostatic proteins are not regulated by the liver.

Plasma levels of coagulation factors differ profoundly between adults and children, but are remarkably stable throughout adulthood. It is unknown which factors determine plasma levels of coagulation factors in a given individual. We hypothesized that the liver, which synthesizes coagulation factors, also controls plasma levels. We measured a panel of coagulation factors in samples taken from either adults or young children who underwent a liver transplantation with adult donor livers. Samples were taken 1-3 months after transplantation, when the patients were clinically stable with adequate graft function. After liver transplantation, the hemostatic profile of the pediatric group was remarkably different from that of the adult group, and resembled the hemostatic profile of normal children. Thus, children transplanted with an adult liver graft maintain a pediatric hemostatic profile after transplantation despite receiving an adult liver graft. These findings suggest that plasma levels of hemostatic proteins are not controlled by the liver.

[1]  M. Morfini,et al.  Implications of coagulation factor VIII and IX pharmacokinetics in the prophylactic treatment of haemophilia , 2011, Haemophilia : the official journal of the World Federation of Hemophilia.

[2]  H. Savoia,et al.  Hemostasis in neonates and children: pitfalls and dilemmas. , 2010, Blood reviews.

[3]  M. Ragni,et al.  Extrahepatic factor VIII production in transplant recipient of hemophilia donor liver. , 2009, Blood.

[4]  M. Montagnana,et al.  Thyroid Dysfunction and Hemostasis: An Issue Still Unresolved , 2009, Seminars in thrombosis and hemostasis.

[5]  G. Banfi,et al.  Biological Variation in Tests of Hemostasis , 2009, Seminars in thrombosis and hemostasis.

[6]  F. Leebeek,et al.  Hemostatic Alterations in Liver Disease: A Review on Pathophysiology, Clinical Consequences, and Treatment , 2007, Digestive Surgery.

[7]  P. Monagle,et al.  Developmental haemostasis , 2006, Thrombosis and Haemostasis.

[8]  P. Giangrande,et al.  Pharmacokinetics of activated recombinant coagulation factor VII (NovoSeven®) in children vs. adults with haemophilia A , 2004, Haemophilia : the official journal of the World Federation of Hemophilia.

[9]  K. Weiss Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. , 2004, Pediatrics.

[10]  R. Brilli,et al.  Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. , 2004, Pediatrics.

[11]  J. Vandenbroucke,et al.  Female hormones and thrombosis. , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[12]  J. V. van Mourik,et al.  Tissue Distribution of Factor VIII Gene Expression In Vivo – A Closer Look , 2001, Thrombosis and Haemostasis.

[13]  M. Nardi,et al.  Synthesis of coagulation proteins in the fetus and neonate. , 2000, Journal of pediatric hematology/oncology.

[14]  M. Woodward,et al.  EPIDEMIOLOGY OF COAGULATION FACTORS, INHIBITORS AND ACTIVATION MARKERS: THE THIRD GLASGOW MONICA SURVEY I. ILLUSTRATIVE REFERENCE RANGES BY AGE, SEX AND HORMONE USE , 1997, British journal of haematology.

[15]  F. Ofosu,et al.  Maturation of the hemostatic system during childhood. , 1992, Blood.

[16]  Boscoe M. Paes,et al.  Development of the human coagulation system in the healthy premature infant. , 1988, Blood.

[17]  B. Schmidt,et al.  Fibrinogen Has a Rapid Turnover in the Healthy Newborn Lamb , 1988, Pediatric Research.

[18]  P. Powers,et al.  Development of the human coagulation system in the full-term infant. , 1987, Blood.