Coagulation management with factor concentrates in liver transplantation: a single-center experience.
BACKGROUND
Allogeneic blood products transfusion during liver transplantation (LT) can be associated with increased morbidity and mortality. Data on thromboelastometry (ROTEM)-guided coagulation management with coagulation factor concentrates (CFCs)-fibrinogen concentrate and/or prothrombin complex concentrate (PCC)-are sparse. We aimed to retrospectively evaluate the safety events observed with this approach in our clinic.


METHODS
LT patients from January 2009 to December 2010 (n = 266) were identified by chart review. A ROTEM-based algorithm with CFC guided the hemostatic therapy. Doppler ultrasound was used to evaluate thrombosis in the hepatic artery, portal vein, and hepatic veins. Stroke, myocardial ischemia, pulmonary embolism, and transfusion variables were recorded. Patients receiving CFC were included in the CFC group (n = 156); those not receiving CFC were included in the non-CFC group (n = 110). Safety events were compared between these two groups.


RESULTS
Allogeneic transfusion(s) in the 266 patients was low, with medians of 2 (interquartile range [IQR], 0-5), 0 (IQR 0-0), and 0 (IQR 0-1) units for red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs), respectively. Ninety-seven of 266 LTs (36.5%) were performed without RBCs transfusion, 227 (85.3%) without FFP, and 190 (71.4%) without PLTs. There were no significant differences in thrombotic, thromboembolic, and ischemic adverse events occurrence between the CFC group and the non-CFC group (11/156 patients vs. 5/110; p = 0.31).


CONCLUSIONS
In LT, ROTEM-guided treatment with fibrinogen concentrate and/or PCC did not appear to increase the occurrence of thrombosis and ischemic events compared to patients who did not receive these concentrates.
Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany.
Carmen
C
Kirchner
Daniel
D
Dirkmann
Jürgen W
JW
Treckmann
Andreas
A
Paul
Matthias
M
Hartmann
Fuat H
FH
Saner
Klaus
K
Görlinger
D000328:Adult; D000465:Algorithms; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D065227:Transfusion Reaction / Q000209:etiology / Q000401:mortality; D018608:Ultrasonography, Doppler
D001779:Blood Coagulation Factors; D005340:Fibrinogen