Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

Arni, Delphine; Wildhaber, Barbara E.; Mclin, Valérie Anne; Rimensberger, Peter C.; Ansari, Marc; Fontana, Pierre; Karam, Oliver

doi:10.1111/vox.12664

Cited by 6 publications

(2 citation statements)

References 35 publications

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“…While these tests may indicate severe coagulopathy, they do not take concomitant alterations of the haemostasis system into account, including decreases in anti‐coagulant proteins, functional defects in fibrinogen, a compensatory increase in von Willebrand factor and enhanced platelet function . It has been suggested that, in patients with liver disease, a rebalanced haemostatic system is present that can easily be tipped towards bleeding or thrombosis .…”

Section: Discussionmentioning

confidence: 99%

Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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Background We investigated changes to transfusion practices over time in paediatric liver transplant centre and evaluated the effect of transfusion practice to mortality.Methods A pilot retrospective study included two cohorts each with 101 sequential paediatric LT recipients: an Early group (1994)(1995)(1996)(1997)(1998) and a Recent group (2009)(2010)(2011)(2012)(2013). Demographic characteristics and data on the intraoperative transfusion of red blood cells (RBC), fresh-frozen plasma (FFP), platelets and cryoprecipitate were collected. Postoperative laboratory results were also obtained, together with donor and data regarding 1-and 5-year survival. Appropriate intergroup comparisons, univariate and multivariate analysis were made and P ≤ 0Á05 was considered statistically significant.Results There were no significant group differences in demographic data (except patient height). Despite the fact that median total blood loss did not differ between groups (111 ml/kg in both groups), the Early group had greater levels of intraoperative RBC transfusion (75 vs. 59 ml/kg, respectively, P = 0Á04) and less use of FFP (53 vs. 62 ml/kg, respectively, P = 0Á01). Overall we noted a lower 1and 5-year survival in the Early group (88Á2% vs. 96%, P = 0Á04 and 82Á4% vs. 89Á1%, P = 0Á01, respectively). Univariate, but not multivariate regression analyses demonstrated that higher PELD score, RBC and FFP transfusion, and inclusion in the Early group were contributing factors to 1-year higher mortality.Conclusions This retrospective analysis of blood loss and replacement in paediatric LT patients demonstrates that the majority of our patients suffer major haemorrhage and require large-volume RBC and FFP replacements. In our pilot study, large volume of RBC and FFP replacement did not contribute to mortality. Paediatric LT involves a number of multidisciplinary teams. Thus, all care-related factors and combinations thereof that may contribute to outcome and should be evaluated in the future.

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Section: Discussionmentioning

confidence: 99%

Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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“…In addition, the use of plasma to correct INR values alone may falsely affect the prognostication of a child's condition and ability to list for transplant as scores typically use INR values in their prognostic models (51). Intraoperative plasma transfusions contribute to the procoagulant state, which increases the risk of thrombotic events (52) and acts as an independent risk factor for the development of patient and graft survival and postoperative complications, including acute kidney injury (53)(54)(55). An RCT comparing a restrictive with a liberal transfusion policy (to maintain a low or high central venous pressure) found that the restrictive policy led to a significant reduction in intraoperative blood loss and transfusion requirements (56,57).…”

Section: Indications Formentioning

confidence: 99%

Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

Lieberman

Karam

Stanworth

et al. 2022

Pediatric Critical Care Medicine

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To present the consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.DESIGN: Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING: Not applicable.PATIENTS: Critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:A panel of 13 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children with malignancy, acute liver disease and/or following liver transplantation, and sepsis and/or disseminated intravascular coagulation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and

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Listing for Transplantation; Postoperative Management and Long-Term Follow-Up

Rock

Mclin

2019

Pediatric Hepatology and Liver Transplantation

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Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

Cited by 6 publications

References 35 publications

Trends in transfusion practice over 20 years in paediatric liver transplant programme

Trends in transfusion practice over 20 years in paediatric liver transplant programme

Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

Listing for Transplantation; Postoperative Management and Long-Term Follow-Up

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