Intraoperative Thromboelastometry as a Predictor of Blood Transfusion Requirements during Adult Living Donor Liver Transplantation

Riffat  Saeed; Amer  Latif; Tariq Ali  Bangash; Syed Mahmood  Ali; Muhammad Khawar  Shahzad; Irfan  Kakepotto; Muhammad  Nasir

doi:10.29054/apmc/2023.1315

Riffat Saeed Assistant Professor, Department of Anesthesia, Shaikh Zayed Hospital, Lahore Pakistan
Amer Latif Associate Professor, Department of Hepatobiliary, Shaikh Zayed Hospital, Lahore Pakistan
Tariq Ali Bangash Associate Professor, Department of Anesthesia, Shaikh Zayed Hospital, Lahore Pakistan
Syed Mahmood Ali Associate Professor, Department of Anesthesia, Shaikh Zayed Hospital, Lahore Pakistan
Muhammad Khawar Shahzad Assistant Professor, Department of Hepatobiliary and Liver Transplant, Shaikh Zayed Hospital, Lahore Pakistan
Irfan Kakepotto Senior Registrar, Department of Anesthesia, Shaikh Zayed Hospital, Lahore Pakistan
Muhammad Nasir Anesthetist, Shaikh Zayed Hospital, Lahore Pakistan

DOI: https://doi.org/10.29054/apmc/2023.1315

Keywords: Liver transplant, Thromboelastometry, Blood transfusion, Blood coagulation

Abstract

Background: Blood transfusion contributes to the correction of hemostasis impairment and perioperative bleeding. Objective: To evaluate the ROTEM variables before the operation to predict the blood transfusion requirements in liver transplant patients. Study Design: A prospective observational study. Settings: This study was carried out at Department of Anesthesia and Hepatobiliary Unit, Shaikh Zayed Hospital, Lahore Pakistan. Duration: From 1^st July 2022 to 31^stDecember 2022. Methods: A total of 100 consecutive patients undergoing liver transplants were included in the study. Thromboelastometry was performed on all patients and quality control was done by ROTROL N on alternate days. Additionally, EXTEM and INTEM were also performed on the days the system was used. When transfusion was needed, fresh frozen plasma (10m/kg), cryoprecipitate (1unit/10kg body weight), and platelets (6 single donor units) were given. A 24% hematocrit was maintained by transfusing packed red blood cells. Blood loss during the procedure was evaluated by applying modified Gross formula. Results: Variables including EXTEM clotting time (95% CI: 1.015-1.264), Maximum clot formation (0.764-0.985), INTEM clotting time (0.897-0.990), Clot formation time (0.955-0.989), and Maximum clot formation (0.416-0.845) were independent predictors of red blood cell transfusion with FIBTEM Maximum clot formation (0.9-1.039) being the dependent predictor. EXTEM clotting time (0.912-0.990), Clot formation time (0.9-1.076), and FIBTEM Maximum clot formation (0.109-0.889) were independent predictors while EXTEM angle α (0.899-2.445) and INTEM variables were dependent predictors of plasma transfusion. In the case of platelet transfusion, EXTEM (1.048-2.131) and INTEM maximum clot firmness (0.299-0.795) were independent predictors. All the thromboelastometric variables in cryoprecipitate transfusion were independent predictors. Conclusion: Thromboelastometry is an efficient method for the prediction of intraoperative bleeding and transfusion requirements during a liver transplant.