Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome.
BACKGROUND
Optimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT).


METHODS
We performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups.


RESULTS
Transfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2-8] to 3 [0-5] (p < 0.001), plasma from 2 [0-4] to 0 (p < 0.001), and platelets from 1 [0-4] to 0 [0-1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications.


CONCLUSIONS
A haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.
Laboratory Medicine Department, Huelva University Hospital (Institute of Biomedicine of Seville, Seville University), Spain. Electronic address: antonio.leonj.sspa@juntadeandalucia.es.
Antonio
A
Leon-Justel
Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain.
Jose A
JA
Noval-Padillo
Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain.
Ana I
AI
Alvarez-Rios
Department of Anaesthesiology, Virgen del Rocío University Hospital, Seville, Spain.
Patricia
P
Mellado
Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain.
Miguel A
MA
Gomez-Bravo
Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain.
Jose M
JM
Álamo
Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain.
Manuel
M
Porras
Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain.
Lydia
L
Barrero
Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain.
Rafael
R
Hinojosa
Department of Haematology and Haemotherapy, Virgen del Rocío University Hospital, Seville, Spain.
Magdalena
M
Carmona
Department of Preventive Medicine and Public Health, University of Seville, Spain.
Angel
A
Vilches-Arenas
Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain.
Juan M
JM
Guerrero
D058186:Acute Kidney Injury / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D017707:Erythrocyte Transfusion / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D006487:Hemostasis; D006489:Hemostatic Techniques; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000191:economics / Q000706:statistics & numerical data; D019095:Point-of-Care Systems; D011183:Postoperative Complications; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome
D006454:Hemoglobins; D005340:Fibrinogen
Blood-loss; Liver-transplantation; Measurement techniques—coagulation; Mobile laboratory; Point of care testing