Hemostatic Markers as Predictors of Massive Blood Transfusion in Orthotopic Liver Transplantation

Milan, Zoka; Ćirković, Andja; Macmillan, Joe; Zaky, Maryam; Pereira, Juliana F.H. Bezerra

doi:10.1016/j.transproceed.2022.01.024

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Patients with previous abdominal surgeries could have collateral vessels and vascularized adhesions which may render liver transplant surgery hemorrhagic. Hemoglobin (<10 g/dL) was another predictor of massive transfusion in our study; it has been identified as the main determinant or among other variables predicting intraoperative blood transfusion in OLT 15,19,38,40,43 . Although some studies have shown that pretransplant coagulation tests were associated with intraoperative bleeding, 23,38,40 the literature is still controversial about the significance of coagulation tests in predicting blood loss.…”

Section: Discussionmentioning

confidence: 48%

“…Hemoglobin (<10 g/dL) was another predictor of massive transfusion in our study; it has been identified as the main determinant or among other variables predicting intraoperative blood transfusion in OLT. 15,19,38,40,43 Although some studies have shown that pretransplant coagulation tests were associated with intraoperative bleeding, 23,38,40 the literature is still controversial about the significance of coagulation tests in predicting blood loss. In our study, aPTT and INR were significant in the univariate analysis; however, the significance was lost in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…De Santis et al studied 166 OLTs and concluded that Child‐Turcotte‐Pugh score, hemoglobin, INR, and total time of liver ischemia were strongly correlated with transfusion during surgery 40 . Other studies found that MELD score, 41 INR, 42 hemoglobin and fibrinogen, 43 and MELD score and fibrinogen 44 to correlate with intraoperative transfusion.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of intraoperative massive transfusion in orthotopic liver transplantation

Alhamar,

Uzuni,

Mehrotra

et al. 2023

Transfusion

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BackgroundAlthough transfusion management has improved during the last decade, orthotopic liver transplantation (OLT) has been associated with considerable blood transfusion requirements which poses some challenges in securing blood bank inventories. Defining the predictors of massive blood transfusion before surgery will allow the blood bank to better manage patients' needs without delays. We evaluated the predictors of intraoperative massive transfusion in OLT.Study Design and MethodsData were collected on patients who underwent OLT between 2007 and 2017. Repeat OLTs were excluded. Analyzed variables included recipients' demographic and pretransplant laboratory variables, donors' data, and intraoperative variables. Massive transfusion was defined as intraoperative transfusion of ≥10 units of packed red blood cells (RBCs). Statistical analysis was performed using SPSS version 17.0.ResultsThe study included 970 OLT patients. The median age of patients was 57 (range: 16–74) years; 609 (62.7%) were male. RBCs, thawed plasma, and platelets were transfused intraoperatively to 782 (80.6%) patients, 831 (85.7%) patients, and 422 (43.5%) patients, respectively. Massive transfusion was documented in 119 (12.3%) patients. In multivariate analysis, previous right abdominal surgery, the recipient's hemoglobin, Model for End Stage Liver Disease (MELD) score, cold ischemia time, warm ischemia time, and operation time were predictive of massive transfusion. There was a direct significant correlation between the number of RBC units transfused and plasma (Pearson correlation coefficient r = .794) and platelets (r = .65).DiscussionPrevious abdominal surgery, the recipient's hemoglobin, MELD score, cold ischemia time, warm ischemia time, and operation time were predictive of intraoperative massive transfusion in OLT.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of intraoperative massive transfusion in orthotopic liver transplantation

Alhamar,

Uzuni,

Mehrotra

et al. 2023

Transfusion

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“…11,16 Studies of hemorrhage during planned surgical procedures show correlation between preoperative and perioperative hypofibrinogenemia-related coagulopathy and increased blood utilization and worse outcomes. [17][18][19][20][21][22][23][24] Use of whole blood (WB) or a 1:1:1 transfusion ratio in trauma provides a balanced resuscitation; however, neither provides concentrated fibrinogen that can rapidly address hypofibrinogenemia or fibrinogen dysfunction when it occurs. Identification of the need for a concentrated source, and ability to immediately respond, is critical for those who would benefit from supplementing fibrinogen.…”

Section: Introductionmentioning

confidence: 99%

“…Fibrinogen, the precursor for fibrin, a key protein in clot formation, is the first clotting factor to reach critically low levels during hemorrhage. 20,25,26 Fibrinogen level below 200 mg dL À1 is an independent risk factor for severe hemorrhage in trauma, 20 cardiovascular, 18 liver transplant, 21,22 and obstetric 19 patients. The European Society for Anaesthesiology guidelines indicate that a fibrinogen concentration of less than 150 to 200 mg dL À1 is considered hypofibrinogenemic.…”

Section: Introductionmentioning

confidence: 99%

Analyzing and modeling massive transfusion strategies and the role of fibrinogen—How much is the patient actually receiving?

Keltner,

Cushing,

Haas

et al. 2024

Transfusion

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BackgroundHemorrhage is a leading cause of preventable death in trauma, cardiac surgery, liver transplant, and childbirth. While emphasis on protocolization and ratio of blood product transfusion improves ability to treat hemorrhage rapidly, tools to facilitate understanding of the overall content of a specific transfusion strategy are lacking. Medical modeling can provide insights into where deficits in treatment could arise and key areas for clinical study. By using a transfusion model to gain insight into the aggregate content of massive transfusion protocols (MTPs), clinicians can optimize protocols and create opportunities for future studies of precision transfusion medicine in hemorrhage treatment.MethodsThe transfusion model describes the individual round and aggregate content provided by four rounds of MTP, illustrating that the total content of blood elements and coagulation factor changes over time, independent of the patient's condition. The configurable model calculates the aggregate hematocrit, platelet concentration, percent volume plasma, total grams and concentration of citrate, percent volume anticoagulant and additive solution, and concentration of clotting factors: fibrinogen, factor XIII, factor VIII, and von Willebrand factor, provided by the MTP strategy.ResultsTransfusion strategies based on a 1:1:1 or whole blood foundation provide between 13.7 and 17.2 L of blood products over four rounds. Content of strategies varies widely across all measurements based on base strategy and addition of concentrated sources of fibrinogen and other key clotting factors.DiscussionDifferences observed between modeled transfusion strategies provide key insights into potential opportunities to provide patients with precision transfusion strategy.

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Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Giabicani,

Joly,

Sigaut

et al. 2024

JHEP Reports

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Hemostatic Markers as Predictors of Massive Blood Transfusion in Orthotopic Liver Transplantation

Cited by 6 publications

References 7 publications

Predictors of intraoperative massive transfusion in orthotopic liver transplantation

Predictors of intraoperative massive transfusion in orthotopic liver transplantation

Analyzing and modeling massive transfusion strategies and the role of fibrinogen—How much is the patient actually receiving?

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

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