Coagulation, hemostasis, and transfusion during liver transplantation

Thai, Carolyn; Oben, Cynthia; Wagener, Gebhard

doi:10.1016/j.bpa.2020.03.002

Cited by 24 publications

(9 citation statements)

References 39 publications

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“…Liver transplantation surgery is often accompanied by massive blood loss and massive transfusion (MT; Eghbal et al, 2019;Iyer et al, 2021). In the past, the decision to transfuse red blood cells (RBC) was based on different hemoglobin thresholds set by anesthesiologists (Thai et al, 2020). Affected by many factors, there are certain differences in blood transfusion practices in different institutions.…”

Section: Introductionmentioning

confidence: 99%

Advancing Prediction of Risk of Intraoperative Massive Blood Transfusion in Liver Transplantation With Machine Learning Models. A Multicenter Retrospective Study

Chen

Liu

Wang

et al. 2022

Front. Neuroinform.

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BackgroundLiver transplantation surgery is often accompanied by massive blood loss and massive transfusion (MT), while MT can cause many serious complications related to high mortality. Therefore, there is an urgent need for a model that can predict the demand for MT to reduce the waste of blood resources and improve the prognosis of patients.ObjectiveTo develop a model for predicting intraoperative massive blood transfusion in liver transplantation surgery based on machine learning algorithms.MethodsA total of 1,239 patients who underwent liver transplantation surgery in three large grade lll-A general hospitals of China from March 2014 to November 2021 were included and analyzed. A total of 1193 cases were randomly divided into the training set (70%) and test set (30%), and 46 cases were prospectively collected as a validation set. The outcome of this study was an intraoperative massive blood transfusion. A total of 27 candidate risk factors were collected, and recursive feature elimination (RFE) was used to select key features based on the Categorical Boosting (CatBoost) model. A total of ten machine learning models were built, among which the three best performing models and the traditional logistic regression (LR) method were prospectively verified in the validation set. The Area Under the Receiver Operating Characteristic Curve (AUROC) was used for model performance evaluation. The Shapley additive explanation value was applied to explain the complex ensemble learning models.ResultsFifteen key variables were screened out, including age, weight, hemoglobin, platelets, white blood cells count, activated partial thromboplastin time, prothrombin time, thrombin time, direct bilirubin, aspartate aminotransferase, total protein, albumin, globulin, creatinine, urea. Among all algorithms, the predictive performance of the CatBoost model (AUROC: 0.810) was the best. In the prospective validation cohort, LR performed far less well than other algorithms.ConclusionA prediction model for massive blood transfusion in liver transplantation surgery was successfully established based on the CatBoost algorithm, and a certain degree of generalization verification is carried out in the validation set. The model may be superior to the traditional LR model and other algorithms, and it can more accurately predict the risk of massive blood transfusions and guide clinical decision-making.

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Section: Introductionmentioning

confidence: 99%

Advancing Prediction of Risk of Intraoperative Massive Blood Transfusion in Liver Transplantation With Machine Learning Models. A Multicenter Retrospective Study

Chen

Liu

Wang

et al. 2022

Front. Neuroinform.

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“…4,8,15,19,41 INR reflects only one side of the coagulation cascade: the activity of the procoagulant factors. 4,19,42 A more comprehensive interpretation of the patient's coagulation profile may have shown suspicion of hyper-coagulability. Specifically, the patient exhibited ETP elevation which preceded the thrombotic event ►Supplementary Appendix B, (available in the online version).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical decision making (i.e., commencement of thromboembolic prophylaxis and management of the epidural catheter) was guided by conventional coagulation tests namely PT, aPTT and INR, , although they are inconsistent for either bleeding or thrombotic risk prediction 4,8,15,19,41. INR reflects only one side of the coagulation cascade: the activity of the procoagulant factors 4,19,42. A more…”

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confidence: 99%

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

et al. 2022

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Hepatectomy induced coagulation disturbances have been well studied over the past decade. Cumulative evidence supports the superiority of global coagulation analysis compared to conventional coagulation tests (i.e. PT or aPTT) for clinical decision making. Cancer, however, represents an acquired prothrombotic state and liver resection for cancer deserves a more thorough investigation. This prospective observational study was conducted to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy. Patients were followed up to the 10th postoperative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors and thrombin generation assay parameters. An abnormal coagulation profile was detected at presentation and included elevated FVIII levels, decreased levels of antithrombin and lag time prolongation in thrombin generation. Serial hematological data demonstrated increased vWF, FVIII, D-dimer, fibrinogen and decreased levels of natural anticoagulant proteins in the early postoperative period predisposing to a hypercoagulable state. The ratio of the anticoagulant protein C to the procoagulant FVIII was low at baseline and further declined postoperatively, indicating a prothrombotic state. Though no bleeding complications were reported, one patient experienced pulmonary embolism while under thromboprophylaxis. Overall, patients with hepatic carcinoma presenting for elective major hepatectomy may have baseline malignancy associated coagulation disturbances, aggravating the hypercoagulable state documented in the early postoperative period.

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“…The substantial blood use encountered during liver transplant has been attributed to multiple factors, including liver failure, splenomegaly, significant surgical bleeding, portal venous overload, thrombocytopenia, platelet dysfunction, fibrinolysis, enhanced proteolysis, and graft dysfunction 3–5 . Clinical transfusion management is further complicated by disturbances of hemostasis that affect both the pro‐ and anticoagulant systems in liver failure, which may result in overlapping phenotypes of bleeding diathesis and thrombosis 6 . Higher rates of transfusion during liver transplant have been associated with increased length of hospital stay, total hospital cost, and higher rates of infection, graft failure, and mortality 5,7–11 …”

Section: Introductionmentioning

confidence: 99%

Blood utilization in liver transplantation (BUILT): A multidisciplinary survey of transfusion practices

et al. 2022

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Background The purpose of this study was to survey liver transplant centers in the United States to assess baseline practices in blood utilization and identify opportunities for standardization to optimize blood use in these complex cases. Study Design and Methods Two surveys, one for transfusion medicine physicians and the other for anesthesiologists, were distributed to high‐volume liver transplant centers. Results The response rate was 52% for both surveys. The majority of respondents (90%) indicated they issue a standardized number of blood products to start surgeries. The most common number of products issued before the start of cases were 10 red blood cells (RBC) and 10 plasma units with no platelets or cryoprecipitate. On average, fewer RBC (7.5) and plasma (7) units were transfused than issued. Decisions to transfuse RhD+ RBCs to RhD‐ patients and use antigen untested units in alloimmunized patients were mainly handled on a case‐by‐case basis. Many centers reported utilizing viscoelastic testing (97%) and cell salvage (97%). Most centers reported standardized, laboratory‐based intraoperative transfusion goals for RBCs (65%) and fibrinogen replacement (52%) but lacked a standardized approach for plasma (55%) and platelets (58%). Discussion More blood products are issued during surgery than are transfused. Responses from anesthesiology providers suggest a broad consensus on practice. Almost all respondents use viscoelastic testing in the management of intraoperative coagulopathy, either alone or in combination with classical coagulation tests. The majority of programs do not transfuse clotting factor concentrates, including fibrinogen concentrate, prothrombin complex concentrates, and recombinant activated FVII, and do not use antifibrinolytics prophylactically.

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Coagulation, hemostasis, and transfusion during liver transplantation

Cited by 24 publications

References 39 publications

Advancing Prediction of Risk of Intraoperative Massive Blood Transfusion in Liver Transplantation With Machine Learning Models. A Multicenter Retrospective Study

Advancing Prediction of Risk of Intraoperative Massive Blood Transfusion in Liver Transplantation With Machine Learning Models. A Multicenter Retrospective Study

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

Blood utilization in liver transplantation (BUILT): A multidisciplinary survey of transfusion practices

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