Use of Rotational Thromboelastometry in Liver Transplantation Is Associated With Reduced Transfusion Requirements

Schumacher, Carsten; Eismann, Hendrik; Sieg, Lion; Friedrich, Lars; Scheinichen, Dirk; Vondran, Florian W. R.; Johanning, Kai

doi:10.6002/ect.2017.0236

Cited by 20 publications

(29 citation statements)

References 31 publications

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“…None of these studies demonstrated a survival benefit when a VET strategy was employed compared to CCT. [39][40][41][42][43][45][46][47]49 Q U E S T I O N 3 , TA B L E 3 Summary of findings leading to the quality of evidence assessment according to the GRADE approach…”

Section: Survivalmentioning

confidence: 99%

“…Multiple studies included in our review suggest that VET-guided transfusion management is associated with decreases in the utilization of allogeneic blood products (PRBC, PLT, and FFP). [39][40][41][42][43]49 The overall QOE is moderate, with the magnitude of effect varying between studies conducted at different centers. Notably, while many studies conducted locally standardized VET-guided and CCT-guided transfusion management with clearly defined transfusion thresholds, there is a lack of overall consensus among centers.…”

Section: Transfusion Requirementsmentioning

confidence: 99%

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Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Yoon,

Bartoszko,

Bezinover

et al. 2022

Clinical Transplantation

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Background Liver transplantation (LT) is frequently complicated by coagulopathy associated with end‐stage liver disease (ESLD), that is, often multifactorial. Objectives The objective of this systematic review was to identify evidence based intraoperative transfusion and coagulation management strategies that improve immediate and short‐term outcomes after LT. Methods PRISMA‐guidelines and GRADE‐approach were followed. Three subquestions were formulated. (Q); Q1: transfusion management; Q2: antifibrinolytic therapy; and Q3: coagulation monitoring. Results Sixteen studies were included for Q1, six for Q2, and 10 for Q3. Q1: PRBC and platelet transfusions were associated with higher mortality. The use of prothrombin complex concentrate (PCC) and fibrinogen concentrate (FC) were not associated with reductions in intraoperative transfusion or increased thrombotic events. The use of cell salvage was not associated with hepatocellular carcinoma (HCC) recurrence or mortality. Cell salvage and transfusion education significantly decreased blood product transfusions. Q2: Epsilon‐aminocaproic acid (EACA) and tranexamic acid (TXA) were not associated with decreased blood product transfusion, improvements in patient or graft survival, or increases in thrombotic events. Q3: Viscoelastic testing (VET) was associated with decreased allogeneic blood product transfusion compared to conventional coagulation tests (CCT) and is likely to be cost‐effective. Coagulation management guided by VET may be associated with increases in FC and PCC use. Conclusion Q1: A specific blood product transfusion practice is not recommended (QOE; low | Recommendation; weak). Cell salvage and educational interventions are recommended (QOE: low | Grade of Recommendation: moderate). Q2: The routine use of antifibrinolytics is not recommended (QOE; low | Recommendation; weak). Q3: The use of VET is recommended (QOE; low‐moderate | Recommendation; strong).

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Section: Survivalmentioning

confidence: 99%

Section: Transfusion Requirementsmentioning

confidence: 99%

Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Yoon,

Bartoszko,

Bezinover

et al. 2022

Clinical Transplantation

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“…Regarding the intraoperative parameters, the mean blood pack transfusion was 9.3 units, compared to the mean of 8.1 blood pack units (11) .…”

Section: Discussionmentioning

confidence: 78%

Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru

Cabezas¹,

Martinez²,

Bermudez³

et al. 2021

Rev Gastroenterol Peru

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Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.

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“…A German group who performed 413 liver transplants over a 5-year period showed an average transfusion of 8.1 (SD 8.1) PRC and 9.5 (SD 7.4) FFP units per case. 6 Similarly, a Taiwanese group reported an average blood transfusion of 4350 mL (SD 6230) for 388 patients per transplant. 7 Our significant utilisation of blood products is slightly concerning as increased transfusion requirements are correlated with worsened outcomes, higher rates of surgical reinterventions, more frequent septic episodes, and prolonged lengths of stay.…”

Section: Discussionmentioning

confidence: 98%

<p>A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation</p>

Gan¹,

Nwankiti²,

Milan³

2019

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Background: Liver transplantation is associated with massive blood loss due to a combination of coagulopathy, portal hypertension, and multiple vascular transection and anastomoses. Multiple blood transfusions over a short time frame may result in significant blood and component wastage due to over-ordering of blood products and component time expiry. Blood wastage in the setting of liver transplantation is yet to be reviewed. We reviewed transfusion practices during liver transplantation and audited blood component and product wastage. Methods: We performed a single-center retrospective review of all adult patients aged >16 years over a period of a year. A total of 181 cases were included in the review. Results: Eighty-seven percent of liver transplants were first transplants and were mainly due to chronic liver failure. Our cohort had a median blood loss of 4249 mL (IQR 2830, 6576) per transplant. Patients having redo procedures or have acute liver failure as a presenting aetiology bled significantly more. Nearly all our patients received blood products during the perioperative period. Fresh frozen plasma (FFP) was transfused in 91.2% of our cohort, followed by packed red cells (PRC, 64.2%), platelets (52.5%) and cryoprecipitates (32.0%). A total of 142 units of blood and blood product were wasted. This equates to a wastage rate of 4.6%. This is higher than the target of 3% set by our institution. Highest wastage rates were seen in FFP (8.6%), followed by PRC (2.2%), cryoprecipitates (1.0%) and platelets (0.9%). The commonest cause of wastage was "time expired". The total cost of wastage is £9800, which represents 3.3% of the total cost of blood products transfused. Conclusion: Changing blood component ordering habits, staff training, and awareness may help reduce wastage of this precious commodity.

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Use of Rotational Thromboelastometry in Liver Transplantation Is Associated With Reduced Transfusion Requirements

Cited by 20 publications

References 31 publications

Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru

<p>A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation</p>

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