The Impact of Thromboelastography on Decreasing Blood Product Usage in Liver Transplantation
Mohamed A, Kitajima T, Shamaa T, Elsabbagh AM, Yoshida A, Abouljoud MS, and Nagai S. The Impact of Thromboelastography on Decreasing Blood Product Usage in Liver Transplantation. J Am Coll Surg 2021; 233(5):e201.
J Am Coll Surg
Introduction: Thromboelastography (TEG) has emerged as a tool to guide resuscitation in Liver Transplantation (LT). We aim to identify effects of TEG utilization on product use and blood loss in LT.
Methods: Adult patients (age >18-years-old) who received LT between 2014 and 2020 were retrospectively reviewed. Living donor, simultaneous/multi-organ transplants, re-transplants, and pediatric transplants were excluded. Impact of TEG on blood products and intraoperative blood loss was analyzed. A subgroup analysis was done based on INR. The median, 75th and 90th percentile of INR at transplant were used as cut-off values. Patients were classified into four categories: no, mild, moderate, and severe coagulopathy groups.
Results: Four-hundred-fifty-one patients met inclusion criteria and were separated into TEG(n=144) vs non-TEG(n=307). Background characteristics between these groups were comparable. Median blood products used were similar between TEG and non-TEG groups. In the subgroup analysis, there was a significant decrease in product use in the TEG-group with moderate coagulopathy, compared to the non-TEG group: pRBC (4.5vs7.0 units, p=0.002); FFP (6.0vs9.0 units, p=0.005); Cryoprecipitate (1.0vs2.0 units, p=0.005). Tranexamic acid (TXA) use was significantly higher in the TEG-group with median values of 1000vs0 mg (p<0.001). There was no difference in median blood loss. In the no, mild, and severe coagulopathy groups, there was no difference in blood product use, blood loss, or TXA use between groups.
Conclusion: TEG guided resuscitation in LT resulted in a decrease in product usage, and more utilization of TXA in patients with moderate coagulopathy defined as INR between 2.2 and 2.8.