Blood component requirements in liver transplantation: effect of 2 thromboelastometry-guided strategies for bolus fibrinogen infusion—the TROMBOFIB randomized trial

Caballero, Marta; Sabaté, Antoni; Gutierrez, Rosa; Beltrán, Joan; Pérez, Lourdes; Pujol, R.; Viguera, Laura; Costa, Montserrat; Reyes, Raquel López; Martínez, Alberto; Ojinaga, Gorka; Leon, Ariadna; Navarro, Antonio Vicente Sempere; Barquero, Marta; Alonso, Guillermo; Puig, Gabriel Beltrán; Blasi, Annabel

doi:10.1016/j.jtha.2022.10.025

Cited by 9 publications

(13 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Organ recovery from controlled cardiac-death donors met the acceptance criteria established by the Spanish Liver Transplantation Society in all centres [ 8 ]. Those criteria stipulate normothermic regional perfusion in the recovery of organs from non-living donors.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with mechanical ventilation longer than 24 h after liver transplantation in patients at risk for bleeding

Caballero,

Sabate,

Perez

et al. 2023

BMC Anesthesiol

Self Cite

View full text Add to dashboard Cite

Background This risk analysis aimed to explore all modifiable factors associated with prolonged mechanical ventilation (lasting > 24 h) after liver transplantation, based on prospectively collected data from a clinical trial. Methods We evaluated 306 candidates. Ninety-three patients were excluded for low risk for transfusion (preoperative haemoglobin > 130 g.l−1), and 31 patients were excluded for anticoagulation therapy, bleeding disorders, familial polyneuropathy, or emergency status. Risk factors were initially identified with a log-binomial regression model. Relative risk was then calculated and adjusted for age, sex, and disease severity (Model for End-Stage Liver Disease [MELD] score). Results Early tracheal extubation was performed in 149 patients (84.7%), and 27 patients (15.3%) required prolonged mechanical ventilation. Reoperations were required for 6.04% of the early extubated patients and 44% of patients who underwent prolonged ventilation (p = 0.001). A MELD score > 23 was the main risk factor for prolonged ventilation. Once modifiable risk factors were adjusted for MELD score, sex, and age, three factors were significantly associated with prolonged ventilation: tranexamic acid (p = 0.007) and red blood cell (p = 0.001) infusion and the occurrence of postreperfusion syndrome (p = 0.004). The median (IQR) ICU stay was 3 (2–4) days in the early extubation group vs. 5 (3–10) days in the prolonged ventilation group (p = 0.001). The median hospital stay was also significantly shorter after early extubation, at 14 (10–24) days, vs. 25 (14–55) days in the prolonged ventilation group (p = 0.001). Eight patients in the early-extubation group (5.52%) were readmitted to the ICU, nearly all for reoperations, with no between-group differences in ICU readmissions (prolonged ventilation group, 3.7%). Conclusion. We conclude that bleeding and postreperfusion syndrome are the main modifiable factors associated with prolonged mechanical ventilation and length of ICU stay, suggesting that trials should explore vasopressor support strategies and other interventions prior to graft reperfusion that might prevent potential fibrinolysis. Trial Registration. European Clinical Trials Database (EudraCT 2018–002510-13,) and on ClinicalTrials.gov (NCT01539057).

show abstract

Section: Methodsmentioning

confidence: 99%

Factors associated with mechanical ventilation longer than 24 h after liver transplantation in patients at risk for bleeding

Caballero,

Sabate,

Perez

et al. 2023

BMC Anesthesiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Caballero et al hypothesized that administering fibrinogen concentrate to reach an A10 value of 11 mm in thromboelastometry during LT could reduce RBCs, other components, and fluid requirements compared to standard care. 10 They performed an RCT including 92 patients in the intervention group who maintained a high A10 value of 11 mm at critical phases of LT and 90 patients in the control group who maintained a standard A10 value of 8 mm. The proportion of patients requiring RBCs did not differ between the groups: intervention, 74.7% (95% CI, 65.5%-83.3%); control, 72.9% (95% CI, 62.2%-82.0%); absolute difference, 1.8% (95% CI, À11.1% to 14.8%).…”

Section: Coagulation/transfusionmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2023

Katayama,

Maffucci,

Domanski

et al. 2024

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

This review highlights noteworthy literature published in 2023 and pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We feature 9 studies from 593 peer-reviewed papers on pancreatic transplantation, 3 from 194 on intestinal transplantation, and 28 from over 4513 on kidney transplantation. The liver transplantation section includes a special focus on 20 studies from 5666 clinical trial publications. We explore a broad range of topics, including donor management, perioperative recipient management, and innovative pharmacologic and mechanical interventions tested for the improvement of patient and graft outcomes and survival.

show abstract

“…The administration of blood products and factor concentrates for coagulopathy correction should be based on algorithms developed for liver transplant patients, guided by VET if available [ 10 ]. In a recent randomized multicenter trial, plasma fibrinogen level and maximum clot firmness (MCF) FIBTEM values were shown to be decreased during liver transplantation, indicating consumption of fibrinogen [ 11 ]. The decrease in fibrinogen level and MCF FIBTEM was more pronounced after graft reperfusion and as a result, nearly 70% of patients required fibrinogen replacement at this time [ 11 ].…”

Section: Management Of Periprocedural Bleeding In Patients With Cirrh...mentioning

confidence: 99%

“…In a recent randomized multicenter trial, plasma fibrinogen level and maximum clot firmness (MCF) FIBTEM values were shown to be decreased during liver transplantation, indicating consumption of fibrinogen [ 11 ]. The decrease in fibrinogen level and MCF FIBTEM was more pronounced after graft reperfusion and as a result, nearly 70% of patients required fibrinogen replacement at this time [ 11 ]. This is demonstrated by the ROTEM tests of patients undergoing liver transplantation in Fig.…”

Section: Management Of Periprocedural Bleeding In Patients With Cirrh...mentioning

confidence: 99%

Treating periprocedural bleeding in patients with cirrhosis

Sabate,

Scarlatescu

2024

J Thromb Thrombolysis

Self Cite

View full text Add to dashboard Cite

Patients with cirrhosis are known to have an abnormal coagulation status, which is a particular concern when planning invasive procedures in which blood loss is possible or predictable. Careful consideration must be given to the bleeding risk for each individual patient and coagulation management strategies should be established in advance of procedural interventions, where possible. Perioperative clinical decision-making should utilize viscoelastic testing in addition to usual assessments, where possible, and focus on the well-established three pillars of patient blood management: optimization of erythropoiesis, minimization of bleeding and blood loss, and management of anemia. Restrictive transfusion policies, careful hemostatic monitoring, and a proactive approach to predicting and preventing bleeding on an individual patient basis should be central to managing perioperative bleeding in the fragile patient population with cirrhosis. This review discusses coagulation assessments and bleeding management techniques necessary before, during, and after surgical interventions in patients with cirrhosis, and provides expert clinical opinion and physician experience on the perioperative management of these patients.

show abstract

Blood component requirements in liver transplantation: effect of 2 thromboelastometry-guided strategies for bolus fibrinogen infusion—the TROMBOFIB randomized trial

Cited by 9 publications

References 14 publications

Factors associated with mechanical ventilation longer than 24 h after liver transplantation in patients at risk for bleeding

Factors associated with mechanical ventilation longer than 24 h after liver transplantation in patients at risk for bleeding

Abdominal Organ Transplantation: Noteworthy Literature in 2023

Treating periprocedural bleeding in patients with cirrhosis

Contact Info

Product

Resources

About