title: Low plasma fibrinogen levels and blood product transfusion in liver transplantation.
abstract: BACKGROUND
  Risk of bleeding in liver transplantation is determined by surgical technique, preoperative hemoglobin and antifibrinolitic therapy. We hypothesized that keeping these confounders factors identical, preoperative plasma fibrinogen level of ≤2 g/L influenced on blood product requirements.
  
  
  METHODS
  Adult patients underwent orthotropic liver transplantation (LT) during the period between January 1998 and December 2009. Cases were selected according to a propensity matching analysis meeting the following criteria: surgical vena cava preservation, tranexamic acid administration and hemoglobin range between 90 to 120 g/L. Intraoperative management was protocolized. The main variable was the percentage of patients that did not require red blood cells (RBC's).
  
  
  RESULTS
  Six hundred sixty-four patients with LT, 208 excluded, 266 who cannot be matched, the analysis was performed on 190 patients. Two cohorts: Low fibrinogen (≤2 g/L) (61 cases) and standard fibrinogen (>2 g/L) (129 cases) were analyzed. Preoperative platelet count (73.5±52 vs. 104±65; 103/mm3) was different in contrast to the hemoglobin (104.2±8.6 vs. 105.6±8.3; g/L). Use of RBC's resulted significantly higher in the low fibrinogen group (median, 3 vs. 2). The number of patients with no blood product requirements was fewer in the low fibrinogen group (8 cases, 13% vs. 45 cases, 35%). The critical level of plasma fibrinogen (1 g/L) was reached after graft reperfusion in 7 cases (5.5%) in the standard fibrinogen group vs. 24 cases (39%) in the low fibrinogen group.
  
  
  CONCLUSIONS
  Our data suggest that preoperative plasma fibrinogen level of ≤2 g/L increases requirements for blood products during the surgical procedure of liver transplantation.
authors.affiliation: Department of Anesthesia and Resuscitation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain - asabatep@bellvitgehospital.cat.
authors.forename: M
authors.initials: M
authors.lastname: Costa
authors.forename: A
authors.initials: A
authors.lastname: Dalmau
authors.forename: A
authors.initials: A
authors.lastname: Sabate
authors.forename: M
authors.initials: M
authors.lastname: Koo
authors.forename: I
authors.initials: I
authors.lastname: Aparicio
authors.forename: L
authors.initials: L
authors.lastname: Contreras
mesh_terms: D000347:Afibrinogenemia / Q000150:complications*; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005340:Fibrinogen; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D005340:Fibrinogen