title: Timing of factor VIIa in liver transplantation impacts cost and clinical outcomes.
abstract: OBJECTIVE
  To investigate the clinical and economic outcomes associated with the use of recombinant factor VIIa (rFVIIa) in perioperative liver transplantation (LT).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 63 adults who underwent LT between January 2000 and September 2008 and received rFVIIa prior to or during the procedure. Using a propensity-scoring method, these patients were matched in a 1:2 ratio with 120 controls.
  
  
  RESULTS
  Of the 473 patients who received any LT during the study period, 63 (13%) received rFVIIa and were matched with propensity score matched controls at a ratio of approximately 1:2. Of those who received rFVIIa, 27 (43%) received preemptive administration and 14 (22%) received intraoperative administration. (The remaining 22 patients received rFVIIa outside of a 12-hour window of time before or after surgery.) Clinical outcomes were similar between the preemptive and the control groups, although patients in the control group had a shorter length of stay in the intensive care unit (ICU) and incurred fewer expenses. Compared with both the preemptive and the control groups, patients who received rFVIIa intraoperatively required more blood products, longer stays in the ICU, and incurred higher costs. They also had poorer graft survival and decreased overall survival rates at 30 days and 1 year.
  
  
  CONCLUSIONS
  Intraoperative administration of rFVIIa in LT was associated with higher blood product use, lower graft and patient survival rates, longer ICU stays, and higher overall costs compared with preemptive administration. The use of preemptive rFVIIa in select high-risk LT patients may prevent the development of poor clinical outcomes and may be more cost effective compared with intraoperative administration.
authors.affiliation: Department of Pharmacy, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Scheffert
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003029:Coagulants / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D015942:Factor VIIa / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D016031:Liver Transplantation; D011300:Preoperative Care; D057216:Propensity Score; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa