ROTEM is useful for the global assessment of coagulation in the operating theatre. EXTEM was the most informative for assessing the whole coagulation process and A10 showed value in guiding Plt and Fg transfusion.

Orthotopic liver transplantation (OLT) remains a potentially hemorrhagic procedure. Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during OLT. Whether it allows blood loss and transfusions to be reduced during OLT remains controversial. Excellent correlations and predictive values have been found between ROTEM parameters and fibrinogen. We hypothesized that the use of a ROTEM-based transfusion algorithm during OLT would lead to more fibrinogen transfusion and decreased bleeding and blood transfusion. Sixty adult patients were consecutively included in a prospective, without-versus-with study: 30 in the group without ROTEM results and 30 in the group with the ROTEM-based algorithm. A small and nonsignificant increase in median fibrinogen transfusions was found for the with group (6.0 g versus 4.5 g, P 5 0.50). It was not associated with a decrease in blood transfusions or in the number of patients exposed to blood products. Liver Transpl 21:169-179, 2015. V C 2014 AASLD.Received June 26, 2014; accepted October 12, 2014.Orthotopic liver transplantation (OLT) remains a surgical procedure associated with major bleeding despite recent advances in the understanding and management of coagulation defects.1-3 Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during cardiac surgery, for trauma patient care, and during OLT. 4,5 Good correlations have been found between ROTEM and laboratory results in the setting of OLT, 6,7 and transfusion algorithms have been implemented by anesthesia teams. However, ROTEM's ability to reduce blood loss and transfusions during OLT remains controversial. 8,9 ROTEM use is recommended by the European Society of Anaesthesiology.10 After a first study in which we gained experience and evaluated correlations between ROTEM parameters and standard laboratory tests, 6 we conducted a prospective, comparative withoutversus-with study to evaluate the impact of a ROTEM-based transfusion algorithm on transfusions and bleeding during OLT. We also performed laboratory blood analyses to manage blood cell counts and Abbreviations: A10, clot amplitude at 10 minutes; aPTT, activated partial thromboplastin time; AUC, area under the curve; ELT, euglobulin lysis time; FFP, fresh frozen plasma; ICU, intensive care unit; NPV, negative predictive value; OLT, orthotopic liver transplantation; PPV, positive predictive value; RBC, red blood cell; ROC, receiver operating characteristic; ROTEM, rotational thromboelastometry; TEG, thromboelastography.St ephanie Roullet and François Sztark have received honoraria from LFB Biom edicaments for lectures.LFB Biom edicaments and Tem-International financed the leasing of the rotational thromboelastometry device and provided the rotational thromboelastometry reagents.Address reprint requests to St ephanie Roullet, M.D., Service d'Anesth esie R eanimation 1

No abstract

Fatty liver disease, including liver steatosis, is a major health problem worldwide. In liver transplantation, macrovesicular steatosis in donor livers is a major cause of graft failure and remains difficult to assess. On one hand, several imaging modalities can be used for the assessment of liver fat, but liver biopsy, which is still considered the gold standard, may be difficult to perform in this context. On the other hand, computed tomography (CT) is commonly used by teams managing cadaveric donors to assess donors and to minimize the risk of complications in recipients. The purpose of our study was to validate the use of CT as a semiquantitative method for assessing macrovesicular steatosis in cadaveric donors with liver biopsy as a reference standard. A total of 109 consecutive cadaveric donors were included between October 2009 and May 2011. Brain death was diagnosed according to French legislation. Liver biopsy and then CT were performed on the same day to determine the degree of macrovesicular steatosis. All liver biopsies and CT scans were analyzed in a double-blinded fashion by a senior pathologist and a senior radiologist, respectively. For CT, we used the liver-to-spleen (L/S) attenuation ratio, which is a validated method for determining 30% or greater steatosis in living liver donors. Fourteen of 109 biopsies exhibited macrovesicular steatosis > 30% upon histologic analysis. A receiver operating characteristic curve was generated for the L/S ratio to identify its ability to predict significant steatosis, which was defined as >30%. A cutoff value of 0.9 for the CT L/S ratio provided a sensitivity of 79% and a specificity of 97% to detect significant steatosis. Liver Transpl 21:690-695, 2015. V C 2015 AASLD.

SVV-FloTrac and SVV-Doppler measurements show acceptable bias and limits of agreement, and similar performance in terms of fluid responsiveness in patients undergoing liver transplantation.