Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies

Abstract

The risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27–2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy.

Goal-Directed Use of Prothrombin Complex Concentrates in Liver Transplantation: Is a Plasma-Free Procedure Feasible?

“…Administration of PCC in patients undergoing LT to correct hemostatic abnormalities appears to be possible and well tolerated, and the use of four-factor PCC could have the potential to significantly reduce the perioperative use of allogenic blood products including FFP [ 9 ]. However, clinical evidence on the efficacy and safety of PPC administration in patients undergoing LT is low, and it has not been definitively ascertained whether or not this practice may increase the risk of thromboembolic complications in the perioperative period.…”

“…Prothrombin complex concentrates (PCCs) are frequently used to correct coagulation abnormalities in patients with acute or chronic liver disease undergoing liver transplantation (LT) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. The main reason for this practice is the multiple advantages that PCC use might have in LT patients, particularly when compared to fresh frozen plasma (FFP) or other pro-coagulant drugs.…”