This pediatric organ transplant team from Poland reports effective use of rFVIIa in 40 patients immediately before liver transplant surgery, and is reporting efficacy in 7 children presenting with severe coagulopathy and non-surgical bleeding after graft reperfusion. Six patients required one dose and one patient received 2 doses, range 37-148 mcg/kg. Antifibrinolytic medication (aprotinin and tranexamic acid) was also used. There was significant reduction in INR and amount of bleeding, and no significant recurrent bleeding in any patient or thrombotic complications. Two patients died with multiorgan failure. The authors conclude that rFVIIa provides effective and safe hemostasis in liver transplant surgery. However, randomized studies are required to prove this efficacy and safety.

– Maadh Aldouri