Impact of Intraoperative Coagulation Factor Concentrates during Pediatric Liver Transplantation: A Retrospective, Propensity-Matched Study.

INTRODUCTION

Coagulopathy is a common issue in pediatric Liver Transplantation (LT), and bleeding can lead to increased morbidity and mortality. However, there is limited research on the use of coagulation factor complexes, specifically Fibrinogen Concentrate (FibC) and Prothrombin Complex Concentrate (PCC), in pediatric LT.

METHODS

The study identified pediatric patients who underwent LT between March 2019 and December 2024. Patients who received FibC and PCC were categorized into the FibC group (Group F, n=150), while those who did not receive FibC and PCC were assigned to the control group (Group C, n=348). After 1:1 propensity score matching, 118 patients were included in each group for analysis. The primary endpoint was the need for Red Blood Cell (RBC) transfusion in pediatric patients undergoing LT.

RESULTS

The volume of RBC infusion during surgery was significantly higher in Group F compared to Group C, with a median [interquartile range] of 800.00 [600.00, 1000.00] ml for Group F versus 600.00 [400.00, 900.00] ml for Group C (p=0.004). During surgery, Group F experienced greater bleeding and required tranexamic acid. Furthermore, 24 hours after surgery, there was no significant difference between the two groups in terms of volume of intraperitoneal drainage or amount of RBC transfusion. The postoperative PT and INR levels in group F were significantly lower than those in group C, whereas fibrinogen levels were significantly elevated. There were no notable differences in postoperative complications, including embolism, between groups.

DISCUSSION: The factors affecting the clinical effectiveness of coagulation factor concentrates during pediatric liver transplantation are complex and multifaceted.

CONCLUSION

This retrospective study indicated that the use of FibC and PCC as an adjunct to FFP did not lead to decreased transfusion requirements for children experiencing bleeding during liver transplantation. No thromboembolic complications related to FibC and PCC administration were noted.