Major Thromboembolic Complications in Liver Transplantation: The Role of Rotational Thromboelastometry and Cryoprecipitate Transfusion.

Tytuł:: Major Thromboembolic Complications in Liver Transplantation: The Role of Rotational Thromboelastometry and Cryoprecipitate Transfusion.
Autorzy:: Nguyen-Buckley C; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Gao W; Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Agopian V; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Wray C; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Steadman RH; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Xia VW; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Źródło:: Transplantation [Transplantation] 2021 Aug 01; Vol. 105 (8), pp. 1771-1777.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore, Williams & Wilkins.
MeSH Terms:: Blood Transfusion*
Liver Transplantation/*adverse effects
Postoperative Complications/*etiology
Thrombelastography/*methods
Thromboembolism/*etiology
Adult ; Aged ; Factor VIII ; Female ; Fibrinogen ; Humans ; Logistic Models ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies
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Substance Nomenclature:: 0 (cryoprecipitate coagulum)
9001-27-8 (Factor VIII)
9001-32-5 (Fibrinogen)
Entry Date(s):: Date Created: 20200828 Date Completed: 20210812 Latest Revision: 20210812
Update Code:: 20240105
DOI:: 10.1097/TP.0000000000003427
PMID:: 32852404
: Czasopismo naukowe

Background: Although hemorrhage is a major concern during liver transplantation (LT), the risk for thromboembolism is well recognized. Implementation of rotational thromboelastometry (ROTEM) has been associated with the increased use of cryoprecipitate; however, the role of ROTEM-guided transfusion strategy and cryoprecipitate administration in the development of major thromboembolic complications (MTCs) has never been documented.
Methods: We conducted a study on patients undergoing LT before and after the implementation of ROTEM. We defined MTC as intracardiac thrombus, pulmonary embolism, hepatic artery thrombosis, and ischemic stroke in 30 d after LT. We used a propensity score to match patients during the 2 study periods.
Results: Among 2330 patients, 119 (4.9%) developed MTC. The implementation of ROTEM was significantly associated with an increase in cryoprecipitate use (1.1 ± 1.1 versus 2.9 ± 2.3 units, P < 0.001) and MTC (4.2% versus 9.5%, P < 0.001). Further analysis demonstrated that the use of cryoprecipitate was an independent risk factor for MTC (odds ratio 1.1, 95% confidence interval 1.04-1.24, P = 0.003). Patients with MTC had significantly lower 1-y survival.
Conclusions: Our study suggests that the implementation of ROTEM and the use of cryoprecipitate play significant roles in the development of MTC in LT. The benefits and risks of cryoprecipitate transfusion should be carefully evaluated before administration.
(Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Comment in: Transplantation. 2021 May 1;105(5):e58-e59. (PMID: 33901131)
Comment in: Transplantation. 2021 May 1;105(5):e60. (PMID: 33901132)

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