Association between intraoperative rotational thromboelastometry or conventional coagulation tests and bleeding in liver transplantation: an observational exploratory study

Authors: Carrier, FM.; Denault, AY.; Nozza, A; Rioux-Masse, B; Roy, A; Massicotte, L.

Affiliations: Ctr Hosp Univ Montreal CHUM, Dept Anaesthesiol, Montreal, PQ, Canada ; Ctr Hosp Univ Montreal CHUM, Crit Care Div, Dept Med, Montreal, PQ, Canada ; Ctr Hosp Univ Montreal CHUM, Ctr Rech, Montreal, PQ, Canada ; Inst Cardiol Montreal, Dept Anaesthesiol, Montreal, PQ, Canada ; Montreal Hlth Innovat Coordinating Ctr MHICC, Montreal, PQ, Canada ; Ctr Hosp Univ Montreal CHUM, Dept Med, Haematol Div, Montreal, PQ, Canada ; Ctr Hosp Univ Montreal CHUM, Dept Surg, Hepatobiliaty Surg, Montreal, PQ, Canada.

Publication: Anaesthesia Critical Care & Pain Medicine

Abstract: INTRODUCTION: Liver transplantation is associated with major blood loss and transfusions. Our objective was to evaluate the association between coagulation results (rotational thromboelastometry (ROTEM) and conventional coagulation tests) and intraoperative bleeding or perioperative red blood cell (RBC) transfusions in liver transplantation. METHODS: We measured ROTEM values and conventional coagulation tests at the beginning of surgery, after graft reperfusion and at the end of surgery. We did bivariate correlation and multivariable regression analyses to explore the association between test results and either intraoperative bleeding or perioperative RBC transfusions. RESULTS: We enrolled 75 consecutive patients. Median [Q1-Q3] intraoperative blood loss was 1400 mL [675-2300] and 59% of patients did not receive any RBC transfusion either intraoperatively or postoperatively. In multivariable analyses, FIBTEM maximal clot firmness (MCF) measured at the beginning of surgery was associated with lower intraoperative blood loss (beta = -106 mL for each mm; 95% CI, -203 to -9 mL). Both a higher haemoglobin concentration (multiplicative factor = 0.89 for each g/L; 95% CI, 0.84 to 0.95) and FIBTEM MCF measured at the end of surgery (multiplicative factor = 0.68 for each mm; 95% CI, 0.48 to 0.95) were associated with fewer postoperative RBC transfusions. CONCLUSION: FIBTEM MCF was strongly associated with intraoperative blood loss and postoperative transfusions while other coagulation results were not. This study might inform future clinical trials on ROTEM-based interventions in liver transplantation.