Use of aprotinin in pediatric organ transplantation

Background. Pediatric thoracic organ transplantation is associated with an increased risk of perioperative bleeding. Many of these patients are undergoing repeat surgical procedures and in general require cardiopulmonary bypass. Methods. This article reviews the efficacy and safety of the serine protease inhibitor aprotinin in improving hemostasis in pediatric transplantation. Results. A review of the literature and investigations from Children's Hospital of Philadelphia suggest that aprotinin is beneficial in pediatric lung transplantation: high-risk patients do as well as low-risk patients. Aprotinin also appears to be of benefit in redo heart transplantations, particularly in patients who have had previous sternotomy or previous transplantation. Repeat use of aprotinin appears to be safe and does reduce blood loss in retransplantation patients. Use in the pump prime and a maintenance dose of aprotinin may be the most effective protocol. At this time, however, it is uncertain whether aprotinin is valuable in primary heart transplantation in low-risk patients. Conclusions. Current practice at Children's Hospital of Philadelphia is to use aprotinin in all lung and heart-lung transplantations and in all redo transplantations: lung, heart-lung, and heart. The use of aprotinin in primary heart transplantations is limited to patients who have had previous sternotomies or thoracotomies. (C) 1998 by The Society of Thoracic Surgeons.