The effect of a viscoelastic-guided bleeding algorithm implementation on blood products use in adult liver transplant patients. A propensity score-matched before-after study |
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| Institution: | 1. Department of Anaesthesia and Intensive Care Medicine III, Fundeni Clinical Institute, Fundeni Street No. 258, Bucharest, 022328, Romania;2. Evangelical Hospital Vienna, 1180, Vienna, Austria;3. Sigmund Freud Private University, Medical Faculty, Campus Prater, 1020, Vienna, Austria;4. “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, Bucharest, 020021, Romania;1. Department of Environmental Health, National Institute of Public Health, 351-0197, Wako, Japan;2. Hiroshima High-Precision Radiotherapy Cancer Center, 732-0057, Hiroshima, Japan;3. Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 734-8551, Hiroshima, Japan;1. Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran;2. Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;3. Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran;5. Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran;1. Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt;2. Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt;3. Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Egypt;1. Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland;2. Division of Hematology, University Hospital Basel, Switzerland;3. School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland;4. Division of Transplant Immunology and Nephrology, University Hospital Basel, Switzerland |
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| Abstract: | BackgroundPerioperative blood products transfusion is correlated with increased morbidity and mortality in liver transplantation (LTx). The objectives of our study are to assess the effect of a standardized viscoelastic test (VET)-guided bleeding management algorithm implementation on intraoperative bleeding, allogenic blood products and factor concentrates requirements and on early postoperative complications in LTx.MethodsRetrospective before-after study comparing two matched cohorts of patients undergoing LTx before (control cohort) and after (intervention cohort) the implementation of a VET-based bleeding algorithm in a single center academic hospital.ResultsAfter propensity score matching, we included 94 patients in each cohort. Patients in intervention cohort received significantly less blood products, fresh frozen plasma (FFP), and cryoprecipitate (p < 0.001 for each), while the amount of fibrinogen concentrate used was significantly higher (p < 0.001). Postoperatively, intervention cohort patients had significantly lower postoperative hemoglobin and fibrinogen levels and longer prothrombin time compared to control cohort. There were no significant differences in red blood cells transfusions, intraoperative bleeding, early postoperative complications, and short term survival.ConclusionsThe implementation of a VET-guided bleeding algorithm decreases allogenic blood products requirements, mainly FFP use and allows a more restrictive management of coagulopathy in patients with chronic liver disease undergoing LTx. |
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| Keywords: | Blood transfusion Bleeding Liver transplantation Viscoelastic tests Hemostasis |
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