Original Clinical Science-Liver Background. Liver transplantation is a high-risk surgery associated with important perioperative bleeding and transfusion needs. Uncertainties remain on the association between preoperative fibrinogen level and bleeding in this population. Methods. We conducted a cohort study that included all consecutive adult patients undergoing a liver transplantation for end-stage liver disease in 1 center. We analyzed the association between the preoperative fibrinogen level and bleeding-related outcomes. Our primary outcome was intraoperative blood loss, and our secondary outcomes were estimated perioperative blood loss, intraoperative and perioperative red blood cell transfusions, reinterventions for bleeding and 1-y graft and patient survival. We estimated linear regression models and marginal risk models adjusted for all important potential confounders. We used restricted cubic splines to explore potential nonlinear associations and reported dose-response curves. Results. We included 613 patients. We observed that a lower fibrinogen level was associated with a higher intraoperative blood loss, a higher estimated perioperative blood loss and a higher risk of intraoperative and perioperative red blood cell transfusions (nonlinear effects). Based on an exploratory analysis of the dose-response curves, these effects were observed below a threshold value of 3 g/L for these outcomes. We did not observe any association between preoperative fibrinogen level and reinterventions, 1-y graft survival or 1-y patient survival. Conclusions. This study suggests that a lower fibrinogen level is associated with bleeding in liver transplantation. The present results may help improving the selection of patients for further studies on preoperative fibrinogen administration in liver transplant recipients with end-stage liver disease.

Background: Standard colonoscopy practice requires removal and histological characterization of almost all small (<10 mm) and diminutive (≤5 mm) colorectal polyps found. The aim of this study was to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small and diminutive polyps, without the need for pathology. Methods: A post hoc analysis was performed on patients enrolled in a prospective colonoscopy study. The primary outcome was surveillance interval agreement of the PBRD strategy compared with pathology-based management according to the 2020 USMSTF guidelines. A chart analysis also evaluated clinician adherence to the pathology-based recommendations for included patients. One-sided testing was performed with a null-hypothesis of 90% agreement with pathology-based surveillance intervals and a two-sided 96.7% CI using correction for multiple testing. Results: 452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8% (96.7% CI [96.3% ; 99.3%]) of patients when comparing to pathology-based management. The PBRD strategy reduced pathological examinations by 58.7% while providing 87.8% of patients immediate surveillance interval recommendation on the day of the colonoscopy compared with 47.1% when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3% adherence to the pathology-based guideline. Conclusion: The PBRD strategy surpassed the 90% agreement with the pathology-based standard for determining subsequent colonoscopy surveillance interval. Furthermore, it reduced the need for pathological examinations and increased the proportion of patients receiving correct surveillance interval recommendations issued on the day of the colonoscopy. The PBRD strategy does not require any expertise in optical diagnosis and may replace any histological characterization of small and diminutive colorectal polyps.

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