Retrospective statistical analysis of coagulation parameters after 250 liver transplantations.
Extensive transfusion of blood components as a typical feature of OLT has been described by many authors. The perioperative requirement for transfusion, however, follows a downward trend, although the indications for OLT have been extended. Functional disturbances such as hyperfibrinolysis or platelet dysfunction, demonstrated by laboratory tests, such as platelet counts, PT, aPTT, TT, fibrinogen, and ATIII are often used to direct the transfusion of blood components, although preoperative data give insight only into the insufficient function of the old liver, which will be explanted and replaced by the donor graft. We have described a retrospective statistical analysis of laboratory data, clinical data, and perioperative blood requirements from 250 liver transplantations performed in our hospital from 1988 to 1992. The OLT was performed according to the usual surgical methods using a venovenous bypass system. Intraoperatively, volume was restored with packed RBC and FFP according to hemodynamic data, hemoglobin, and diuresis; clotting data were not used as indications for blood replacement. This analysis demonstrated that neither preoperative nor intraoperative clotting parameters were able to allow a prediction of the intraoperative requirement for transfusion of blood components; these findings parallel those of previous reports. With respect to other studies showing that perioperative transfusion rates correlated with postoperative infections and mortality, we strongly suggest that perioperative clotting measures as indicators for transfusion requirement should be analyzed with caution. Whether other diagnostic methods such as TEG are useful alternatives has to be determined.
Gerlach
H
H
Department of Surgery, University Clinic Rudolf Virchow, Free University of Berlin, Germany.
Slama
K J
KJ
Bechstein
W O
WO
Lohmann
R
R
Hintz
G
G
Abraham
K
K
Neuhaus
P
P
Falke
K
K
D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D001780:Blood Coagulation Tests / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D015993:Life Tables; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis
D000933:Antifibrinolytic Agents