Fig. 3.

Differential timing of the fibrinolysis shutdown in liver transplant. This figure represents previously unpublished data in liver transplant in which serial viscoelastic tests demonstrate the shutdown of fibrinolysis activity followed by the increase of fibrinolysis inhibitors. This two-step process is highlighted by the top panel in with LY30 is abruptly decreased at 30 minutes of reperfusion of the liver. In the lower panel, the addition of exogenous tPA to the viscoelastic test demonstrates that the systemic blood is still sensitive to plasminogen activators. Resistance to fibrinolysis activators is not appreciated until 2 hours after reperfusion. These data support that clearance of fibrinolytic activators occurs as the first step of fibrinolysis shutdown, followed by upregulation of fibrinolytic inhibitors hours later. tPA, tissue plasminogen activator; POD, postoperative day.