Impact of Point-of-Care Assays for Hemostasis Monitoring According to Type of Donor in a Cohort of Liver Transplant Recipients

Abstract

• Donation after circulatory death liver transplant offers excellent outcomes. • Perioperative hemostasis monitoring protocols with a viscoelastic point-of-care testing assay reduce blood loss and transfusion volume. • Use of machine perfusion is likely to further expand donation after circulatory death liver transplant. The aim is to compare 2 groups of liver transplant recipients, according to type of donor, within the framework of a hemostasis monitoring program using a point-of-care testing assay in terms of reduction in transfusion of blood products. This retrospective analytical observational study included 527 liver transplant recipients from 2014 to 2021. Of these, 460 were recipients of livers from donation after brain death (DBD) and 67 were orthotopic liver transplant recipients with donation after cardiac death (DCD). Statistical analysis of differences between the 2 groups included a series of intraoperative variables of blood product consumption: erythrocyte concentrate (red blood cells), fresh frozen plasma, platelets, and fibrinogen concentrates guided by algorithm with a viscoelastic technique using the ClotPro analyzer. The transfusion management was decided according to pre-established guidelines and cutoff values. The mean follow-up period was 40.3 months. Transfused red blood cells and fibrinogen units were significantly higher in the DBD group. The percentage of retransplant was significantly higher in the DCD group, and vascular complications were significantly more frequent in the DCD group ( P < .05). Cox univariate analysis showed that the DCD group had a risk ratio of death significantly higher than 1. Intraoperative monitoring of hemostasis with a point-of-care testing assay reduced blood product requirements. Type of donor had prognostic utility in our cohort. We hypothesize that other variables such as extraction technique, methods used to preserve the allograft, and later complications have a significantly greater impact than perioperative hemostasis management on retransplant rates and death.