Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome

Abstract

BackgroundOptimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT). MethodsWe performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups. ResultsTransfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2–8] to 3 [0–5] (p<0.001), plasma from 2 [0–4] to 0 (p<0.001), and platelets from 1 [0–4] to 0 [0–1] (p<0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13±1.44g (p=0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p<0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p=0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p=0.048, 17% vs. 2%, p<0.001, and 29% vs. 16%, p=0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications. ConclusionsA haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.