Thromboelastography and Liver Transplantation: A Target Group

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Conference Proceeding

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Am J Transplant


Liver dysfunction results in derangement of hemostasis and thrombosis. Thromboelastography (TEG) has emerged as a tool to guide resuscitative efforts. We aim to identify a target population, and analyze the effects of TEG on product use and blood loss in LT. Adult patients (age >18 years of age) who received LT between 2014 and 2020 were retrospectively reviewed. Those patients who underwent living donor, simultaneous or multi-organ transplants, re-transplants, and recipient <18 years of age, were excluded. A subgroup analysis was done based on INR at transplant. The median, 75th, and 90th percentile of INR at transplant were used as cut-off values and patients were classified into four categories: no coagulopathy, mild, moderate, and severe coagulopathy groups. Four hundred fifty-one patients met criteria and were separated into TEG (n=144) vs non-TEG (n=307) groups. Median blood products used, and blood loss were similar between TEG and non-TEG groups (Table 1). In the subgroup analysis, there was a significant decrease in product use in the TEG group with moderate coagulopathy; Tranexamic acid (TXA) use was significantly higher in the TEG with moderate coagulopathy group (Table 2). In the no, mild and severe coagulopathy groups, there was no difference in product/TXA use or blood loss between the two groups. TEG guided hemostasis and resuscitation in LT resulted in a decrease in product usage, as well as more utilization of TXA, likely by recognition of hyper-fibrinolysis, in patients with moderate coagulopathy (INR between 2.2 and 2.8).





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