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Preoperative Thrombelastography Predicts Transfusion Requirements During Liver Transplantation

20 Pages Posted: 8 Nov 2019 Publication Status: Under Review

See all articles by Justin T. Graff

Justin T. Graff

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Alexander R. Cortez

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Vikrom K. Dhar

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Connor Wakefield

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Madison C. Cuffy

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Shimul A. Shah

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Michael D. Goodman

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Abstract

Background: Thrombelastography (TEG) has become increasingly utilized in liver transplantation (LT). The implications of TEG at various stages of LT, however, remain poorly understood. Our goal was to examine TEG-based coagulopathy profiles in LT and determine whether preoperative TEG is predictive of transfusion requirements perioperatively.

Methods: A retrospective review of 364 LTs from January 2013 to May 2017 at a single institution was performed. Patients were categorized as hypocoagulable or nonhypocoagulablebased on their preoperative TEG profile. The primary outcome was intraoperative transfusion requirements.

Results: Of patients undergoing LT, 47% (n=170) were hypocoagulable and 53% (n=194) were non-hypocoagulable preoperatively. Hypocoagulable patients had higher transfusionrequirements compared to non-hypocoagulable patients, requiring more units of pRBC (7 vs.4, p < 0.01), FFP (14 vs. 8, p < 0.01), cryoprecipitate (2 vs. 1, p < 0.01), platelets (3 vs. 2, p <0.01), and cell saver (3 vs. 2 liters, p < 0.01). Additionally, these patients were more likely toreceive platelets and cryoprecipitate in the first 24 hours following LT (both p < 0.05). Nodifference was found between rates of temporary abdominal closure, unplanned reoperation,ICU length of stay, or 30-day readmission (all p > 0.05).

Conclusions: Coagulation abnormalities are common among LT patients and can be identified using TEG. Identification of a patient’s coagulation state preoperatively using TEG may predict transfusion requirements during LT. Preoperative TEG should be used when available to identify patients who may be higher risk for intraoperative coagulopathy and require increased perioperative resource utilization.

Keywords: liver transplantation, thrombelastography, outcomes, coagulopathy

Suggested Citation

Graff, Justin T. and Cortez, Alexander R. and Dhar, Vikrom K. and Wakefield, Connor and Cuffy, Madison C. and Shah, Shimul A. and Goodman, Michael D., Preoperative Thrombelastography Predicts Transfusion Requirements During Liver Transplantation (November 8, 2019). Available at SSRN: https://ssrn.com/abstract=3482814 or http://dx.doi.org/10.2139/ssrn.3482814

Justin T. Graff (Contact Author)

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Alexander R. Cortez

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Vikrom K. Dhar

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Connor Wakefield

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Madison C. Cuffy

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Shimul A. Shah

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS)

Cincinnati, OH
United States

Michael D. Goodman

University of Cincinnati - Cincinnati Research in Outcomes and Safety in Surgery (CROSS) ( email )

Cincinnati, OH
United States

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