Preoperative Thrombelastography Predicts Transfusion Requirements During Liver Transplantation
20 Pages Posted: 8 Nov 2019 Publication Status: Under Review
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
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