The haemostasis system in normal liver disease and liver transplantation

The textbook is devoted to the problem of hemostasis disorders in patients undergoing liver transplantation and their correction in the perioperative period. The following topics are discussed: physiology of the hemostasis system; influence of some anesthetics and drugs on hemostasis in liver transplantation; dysfunctions of the blood coagulation system in patients with diffuse diseases requiring liver transplantation (LT); correction of hemostasis disorders during and after orthotopic LT. In noncholestatic liver injuries changes in hemostasis system are caused by disrupted synthesis of coagulation factors in hepatocytes, which can lead to development of bleeding tendency. In cholestatic liver diseases of great importance in the mechanism of development of disorders in the hemostasis system are changes in the phospholipid composition of membranes of platelets and endotheliocytes. Changes in phospholipid membrane composition are probably caused by appearance of increased amount of bile acids in the general blood flow. Correction of hemostasis disorders in liver transplantation should be done taking into account nosological form of liver damage, mechanisms of hemostasis disorders of a recipient and stage of operation.