Orthotopic liver transplantation (OLT) remains a potentially hemorrhagic procedure. Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during OLT. Whether it allows blood loss and transfusions to be reduced during OLT remains controversial. Excellent correlations and predictive values have been found between ROTEM parameters and fibrinogen. We hypothesized that the use of a ROTEM-based transfusion algorithm during OLT would lead to more fibrinogen transfusion and decreased bleeding and blood transfusion. Sixty adult patients were consecutively included in a prospective, without-versus-with study: 30 in the group without ROTEM results and 30 in the group with the ROTEM-based algorithm. A small and nonsignificant increase in median fibrinogen transfusions was found for the with group (6.0 g versus 4.5 g, P 5 0.50). It was not associated with a decrease in blood transfusions or in the number of patients exposed to blood products. Liver Transpl 21:169-179, 2015. V C 2014 AASLD.Received June 26, 2014; accepted October 12, 2014.Orthotopic liver transplantation (OLT) remains a surgical procedure associated with major bleeding despite recent advances in the understanding and management of coagulation defects.1-3 Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during cardiac surgery, for trauma patient care, and during OLT. 4,5 Good correlations have been found between ROTEM and laboratory results in the setting of OLT, 6,7 and transfusion algorithms have been implemented by anesthesia teams. However, ROTEM's ability to reduce blood loss and transfusions during OLT remains controversial. 8,9 ROTEM use is recommended by the European Society of Anaesthesiology.10 After a first study in which we gained experience and evaluated correlations between ROTEM parameters and standard laboratory tests, 6 we conducted a prospective, comparative withoutversus-with study to evaluate the impact of a ROTEM-based transfusion algorithm on transfusions and bleeding during OLT. We also performed laboratory blood analyses to manage blood cell counts and Abbreviations: A10, clot amplitude at 10 minutes; aPTT, activated partial thromboplastin time; AUC, area under the curve; ELT, euglobulin lysis time; FFP, fresh frozen plasma; ICU, intensive care unit; NPV, negative predictive value; OLT, orthotopic liver transplantation; PPV, positive predictive value; RBC, red blood cell; ROC, receiver operating characteristic; ROTEM, rotational thromboelastometry; TEG, thromboelastography.St ephanie Roullet and François Sztark have received honoraria from LFB Biom edicaments for lectures.LFB Biom edicaments and Tem-International financed the leasing of the rotational thromboelastometry device and provided the rotational thromboelastometry reagents.Address reprint requests to St ephanie Roullet, M.D., Service d'Anesth esie R eanimation 1

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Summary Donor‐derived fungal infections can be associated with severe complications in transplant recipients. Donor‐derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5‐year (2008–2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida‐related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty‐two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7–37 days. Eight patients developed yeast‐related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1‐year mortality rate among patients after a yeast‐related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow‐up may enable early recognition of the arterial complications associated with PF contamination by Candida.

In the in vitro conditions, the Synergy vascular graft combining silver with triclosan demonstrated better short-term antimicrobial activity than the silver graft for all micro-organisms tested.

A value of ΔPP(CNAP) >11% has a sensitivity of at least 62% in predicting preload-dependent responders to VE in mechanically ventilated patients during general anesthesia.