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. 1993 Mar;46(3):222–227. doi: 10.1136/jcp.46.3.222

Pulmonary platelet aggregates: possible cause of sudden peroperative death in adults undergoing liver transplantation.

E A Sankey 1, J Crow 1, S V Mallett 1, R J Alcock 1, L More 1, A K Burroughs 1, K Rolles 1
PMCID: PMC501174  PMID: 8463414

Abstract

AIMS: To determine if massive pulmonary platelet thromboembolism is a common cause of peroperative death following liver transplantation; and to compare the incidence of this event with patients dying after non-transplantation procedures. METHODS: Necropsy tissues from all patients dying within 10 days of operation during the past three and a half years were studied (six liver transplantations and 13 unrelated operations). Haematoxylin and eosin stained sections of all tissues were examined. Additional sections of lung tissue were immunostained for constituents of thrombus (fibrin and platelets). RESULTS: At necropsy the lungs from all six liver transplant recipients were heavy with a rubbery texture and little oedema fluid. Those from non-transplantation patients appeared normal or very oedematous. Microscopic examination showed that there were numerous platelet aggregates occluding pulmonary capillaries in all six transplant recipients, but in only three of the non-transplant patients. These thrombi were numerous in patients dying during surgery and the number was underestimated in routine sections because of the surrounding capillary congestion. Detection was improved by immunostaining for platelets with factor XIIIA and platelet glyco-protein IIIa. CONCLUSIONS: Massive platelet thromboembolism is a likely cause of death in patients dying unexpectedly following recent liver transplantation. Non-transplantation patients dying during surgery who show similar appearances usually have conditions known to have a high risk of thrombosis or embolism (cement hypotension syndrome and disseminated intravascular coagulation). The cause of this extensive platelet activation in liver transplant recipients is uncertain and may be multifactorial. The unusual rubbery consistency of the lungs on macroscopic examination could alert the pathologist to the underlying condition. Immunostaining for platelets improves the detection microscopically.

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Selected References

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  1. Ashford T. P. The etiology of venous thrombi after aortic cross-clamping: an electron microscopic study. Surgery. 1970 Nov;68(5):846–851. [PubMed] [Google Scholar]
  2. Astrup T., Glas P., Kok P. Thromboplastic and fibrinolytic activity in lungs of some mammals. Lab Invest. 1970 May;22(5):381–386. [PubMed] [Google Scholar]
  3. Blaisdell F. W., Lim R. C., Jr, Amberg J. R., Choy S. H., Hall A. D., Thomas A. N. Pulmonary microembolism. A cause of morbidity and death after major vascular surgery. Arch Surg. 1966 Nov;93(5):776–786. doi: 10.1001/archsurg.1966.01330050080012. [DOI] [PubMed] [Google Scholar]
  4. Bowald S., Gerdin B. Pulmonary microembolism during and after aortic cross-clamping in heparinized and non-heparinized pigs. Acta Chir Scand. 1980;146(5):351–356. [PubMed] [Google Scholar]
  5. Edwards B. S., Weir E. K., Edwards W. D., Ludwig J., Dykoski R. K., Edwards J. E. Coexistent pulmonary and portal hypertension: morphologic and clinical features. J Am Coll Cardiol. 1987 Dec;10(6):1233–1238. doi: 10.1016/s0735-1097(87)80123-7. [DOI] [PubMed] [Google Scholar]
  6. Giercksky K. E., Bjorklid E., Prydz H. The effect of intravenous injection of purified human tissue thromboplastin in rats. Scand J Haematol. 1976 Apr;16(4):300–310. doi: 10.1111/j.1600-0609.1976.tb01155.x. [DOI] [PubMed] [Google Scholar]
  7. Gosseye S., van Obbergh L., Weynand B., Scheiff J. M., Moulin D., de Ville de Goyet J., Otte J. B. Platelet aggregates in small lung vessels and death during liver transplantation. Lancet. 1991 Aug 31;338(8766):532–534. doi: 10.1016/0140-6736(91)91099-g. [DOI] [PubMed] [Google Scholar]
  8. Groves A. C., Griffiths J., Leung F. Y., Naiman S. C. Fibrin thrombi in the pulmonary microcirculation of dogs with gram-negative bacteremia. Surg Gynecol Obstet. 1972 Mar;134(3):433–436. [PubMed] [Google Scholar]
  9. Gutmann F. D., Murthy V. S., Wojciechowski M. T., Wurm R. M., Edzards R. A. Transient pulmonary platelet sequestration during endotoxemia in dogs. Circ Shock. 1987;21(3):185–195. [PubMed] [Google Scholar]
  10. Jansson I. G., Hetland O., Rammer L. M., Prydz H. E., Lennquist S. E. Effects of phospholipase C, a tissue thromboplastin inhibitor, on pulmonary microembolism after missile injury of the limb. J Trauma. 1988 Jan;28(1 Suppl):S222–S225. doi: 10.1097/00005373-198801001-00048. [DOI] [PubMed] [Google Scholar]
  11. Konstam M. A., Brockway B. A., Aronovitz M. J., Ramberg K., Palabrica T. M., Otradovec C. L., Cooper A., Hill N. Kinetics of pulmonary platelet deposition and clearance during thrombin-induced microembolism in rabbits. Exp Lung Res. 1989 Dec;15(6):867–879. doi: 10.3109/01902148909069632. [DOI] [PubMed] [Google Scholar]
  12. Mallett S. V., Cox D., Burroughs A. K., Rolles K. The intra-operative use of trasylol (aprotinin) in liver transplantation. Transpl Int. 1991 Dec;4(4):227–230. doi: 10.1007/BF00649108. [DOI] [PubMed] [Google Scholar]
  13. McCandless B. K., Kaplan J. E., Cooper J. A., Malik A. B. Determinants of platelet kinetics: effects of pulmonary microembolism. J Appl Physiol (1985) 1988 Oct;65(4):1716–1722. doi: 10.1152/jappl.1988.65.4.1716. [DOI] [PubMed] [Google Scholar]
  14. Miyata T., Yokoyama I., Todo S., Tzakis A., Selby R., Starzl T. E. Endotoxaemia, pulmonary complications, and thrombocytopenia in liver transplantation. Lancet. 1989 Jul 22;2(8656):189–191. doi: 10.1016/s0140-6736(89)90373-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Nakamura S., Shimokama T., Yoshikawa Y., Watanabe T. Immune complex-induced disseminated intravascular coagulation (DIC). An experimental study. Acta Pathol Jpn. 1990 Jul;40(7):476–485. doi: 10.1111/j.1440-1827.1990.tb01589.x. [DOI] [PubMed] [Google Scholar]
  16. Oka K., Tanaka K. Intravascular coagulation in autopsy cases with liver diseases. Thromb Haemost. 1979 Aug 31;42(2):564–570. [PubMed] [Google Scholar]
  17. Rabinovici R., Esser K. M., Lysko P. G., Yue T. L., Griswold D. E., Hillegass L. M., Bugelski P. J., Hallenbeck J. M., Feuerstein G. Priming by platelet-activating factor of endotoxin-induced lung injury and cardiovascular shock. Circ Res. 1991 Jul;69(1):12–25. doi: 10.1161/01.res.69.1.12. [DOI] [PubMed] [Google Scholar]
  18. Rostagno C., Prisco D., Boddi M., Poggesi L. Evidence for local platelet activation in pulmonary vessels in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease. Eur Respir J. 1991 Feb;4(2):147–151. [PubMed] [Google Scholar]
  19. Wedzicha J. A., Syndercombe-Court D., Tan K. C. Increased platelet aggregate formation in patients with chronic airflow obstruction and hypoxaemia. Thorax. 1991 Jul;46(7):504–507. doi: 10.1136/thx.46.7.504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Yamamoto Y., Hasegawa H., Ikeda K., Ichiyama A. Cervical dislocation of mice induces rapid accumulation of platelet serotonin in the lung. Agents Actions. 1988 Aug;25(1-2):48–56. doi: 10.1007/BF01969093. [DOI] [PubMed] [Google Scholar]

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