Thromboelastographic description of intraoperative coagulopathy in patients undergoing liver transplant surgery: A single-center observational study.

BACKGROUND

Patients undergoing liver transplantation often develop multiple hemostatic abnormalities requiring dynamic transfusion and antifibrinolytic support; however, how hemostatic status changes over time during liver transplant surgery is not well defined, limiting clinicians' ability to anticipate and manage hemostatic instability.

AIM: To describe the distribution of intraoperative coagulation abnormalities across the surgical phases of liver transplantation.

METHODS

We conducted an observational study of adult patients who underwent liver transplantation at Henry Ford Health between January 2017 to April 2022. Intraoperative coagulation data from conventional coagulation tests and 2 thromboelastography (TEG) platforms (TEG 5000 and TEG 6s) were collected. Data were stratified across 4 surgical phases: Pre-anhepatic, anhepatic, post-reperfusion, and end-of-surgery.

RESULTS

Of 364 liver transplant recipients, coagulation abnormalities occurred during all surgical phases, with the highest frequency in the anhepatic and post-reperfusion phases. Platelet dysfunction was the most common abnormality, peaking during post-reperfusion, while hyperfibrinolysis was less frequent and resolved in most patients by the end of surgery. TEG 5000 and TEG 6s showed slightly different result patterns for several parameters, particularly for clot initiation time and fibrinogen activity.

CONCLUSION

TEG was more informative than conventional tests, showing peak coagulation derangements during anhepatic and post-reperfusion phases of liver transplantation, likely driven by platelet dysfunction and warranting increased vigilance for coagulopathy.