Reliability of a point-of-care device for international normalized ratio testing during the three surgical phases of orthotopic liver transplantation: a retrospective observational study

Abstract

Purpose To investigate the reliability of a point-of-care device, the HEMOCHRON Ò Jr. Signature, for measuring the international normalized ratio (INR) during the three surgical phases of liver transplantation. Methods A retrospective review was performed on patients undergoing liver transplantation during July to December 2013. Thirty-one patients who had simultaneous laboratory and point-of-care INR readings from each phase of liver transplant surgery (paleohepatic, anhepatic, and neohepatic) were eligible for inclusion. Bland-Altman analysis, Spearman's rank correlation, and four quadrant plots were used to compare INR results from the point-ofcare device (pocINR) with those from the laboratory (labINR). Results Based on the Bland-Altman analysis, mean biases (95% prediction interval) were 0.10 (0.03 to 0.17), 0.19 (0.12 to 0.27), and 0.21 (0.01 to 0.43) for the paleohepatic, anhepatic, and neohepatic phases, respectively. The pocINR device showed a systematic underestimation of the labINR. The Spearman's rank correlation coefficients (95% confidence interval [CI]) were: Q = 0.90 (95% CI 0.80 to 0.95); Q = 0.92 (95% CI 0.71 to 0.93); and Q = 0.71 (95% CI 0.46 to 0.85), respectively. Direction-of-change analysis between the paleohepatic to anhepatic and the anhepatic to neohepatic phases showed strong concordance of 84% and, also considering the small bias between the measurements, supports the use of the pocINR device in the clinical management of liver transplant surgery. Conclusion Point-of-care INR was accurate prior to hepatic reperfusion, but reliability decreased in the neohepatic phase. RésuméObjectif É tudier la fiabilité d'un dispositif au chevet, l'HEMOCHRON Ò Jr. Signature, pour la mesure du rapport international normalisé (RIN) pendant les trois phases chirurgicales d'une transplantation hépatique. Méthodes : Une analyse rétrospective a été menée sur des patients ayant subi une transplantation hépatique entre juillet et décembre 2013. Trente et un patients ayant des

The Impact of Ischemia/Reperfusion Injury on Liver Allografts from Deceased after Cardiac Death versus Deceased after Brain Death Donors

“…Moreover, as bilirubin is an antioxidant that can stimulate apoptosis of various cells [ 31 , 32 ], the higher Cer18 level in DCD at pre-transplant stage compared with DBD indicates that severe apoptosis took place in DCD hepatocytes. INR, the assessment parameter for coagulation monitoring [ 33 ], indicated the liver injury when its value is elevated, hence, the correlation of INR with Cer18 in DCD post-transplant demonstrates ischemia/reperfusion injury in DCD. The association between C18-ceramide and serum level of creatinine is of interest as renal dysfunction post-transplant has been seen to occur at higher rate in liver transplantation from DCD [ 34 ].…”