The impact of thromboelastography on resuscitation in pediatric liver transplantation

Sujka, Joseph; Gonzalez, Katherine W.; Curiel, Kayla; Daniel, J.; Fischer, Ryan T.; Andrews, Walter S.; Wicklund, Brian M.; Hendrickson, Richard J.

doi:10.1111/petr.13176

Cited by 13 publications

(19 citation statements)

References 14 publications

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“…The RBC and FFP transfusion rates at the authors’ centre were also half of those of our institution . However, using TEG increased the transfusion of platelets and cryoprecipitate . All changes resulted in a higher incidence of serious thromboembolic complications, including portal vein and hepatic artery thrombosis, from 0 to 22% .…”

Section: Discussionmentioning

confidence: 68%

“…The paediatric LT population is much smaller than the adult LT population, and data regarding the transfusion of blood and blood products have only recently started to be reported in the literature .…”

Section: Discussionmentioning

confidence: 99%

“… reported no difference in the volume of RBC and FFP transfusion intraoperatively, following the use of thromboelastography (TEG) in 36 patients studied from 2008 to 2014. The RBC and FFP transfusion rates at the authors’ centre were also half of those of our institution . However, using TEG increased the transfusion of platelets and cryoprecipitate .…”

Section: Discussionmentioning

confidence: 99%

“…However, using TEG increased the transfusion of platelets and cryoprecipitate . All changes resulted in a higher incidence of serious thromboembolic complications, including portal vein and hepatic artery thrombosis, from 0 to 22% . Additionally, the rejection rate increased by 22% after the introduction of TEG monitoring and a change in transfusion policy .…”

Section: Discussionmentioning

confidence: 99%

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Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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Background We investigated changes to transfusion practices over time in paediatric liver transplant centre and evaluated the effect of transfusion practice to mortality.Methods A pilot retrospective study included two cohorts each with 101 sequential paediatric LT recipients: an Early group (1994)(1995)(1996)(1997)(1998) and a Recent group (2009)(2010)(2011)(2012)(2013). Demographic characteristics and data on the intraoperative transfusion of red blood cells (RBC), fresh-frozen plasma (FFP), platelets and cryoprecipitate were collected. Postoperative laboratory results were also obtained, together with donor and data regarding 1-and 5-year survival. Appropriate intergroup comparisons, univariate and multivariate analysis were made and P ≤ 0Á05 was considered statistically significant.Results There were no significant group differences in demographic data (except patient height). Despite the fact that median total blood loss did not differ between groups (111 ml/kg in both groups), the Early group had greater levels of intraoperative RBC transfusion (75 vs. 59 ml/kg, respectively, P = 0Á04) and less use of FFP (53 vs. 62 ml/kg, respectively, P = 0Á01). Overall we noted a lower 1and 5-year survival in the Early group (88Á2% vs. 96%, P = 0Á04 and 82Á4% vs. 89Á1%, P = 0Á01, respectively). Univariate, but not multivariate regression analyses demonstrated that higher PELD score, RBC and FFP transfusion, and inclusion in the Early group were contributing factors to 1-year higher mortality.Conclusions This retrospective analysis of blood loss and replacement in paediatric LT patients demonstrates that the majority of our patients suffer major haemorrhage and require large-volume RBC and FFP replacements. In our pilot study, large volume of RBC and FFP replacement did not contribute to mortality. Paediatric LT involves a number of multidisciplinary teams. Thus, all care-related factors and combinations thereof that may contribute to outcome and should be evaluated in the future.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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“…We should have hand-search the reference list from identified relevant studies and contact the manufacturers of TEG and ROTEM for unpublished trials. If I would have need to contact Sujka, J or would purchase the paper for assess inclusion criteria (32) . A metaanalysis could have been done.…”

Section: Reviews' Limitations and Reflectionsmentioning

confidence: 99%

The effectiveness of Thromboelastography (TEG) or thromboelastometry (ROTEM) to guide transfusion treatment versus usual care in liver transplant.

Rando

2018

AAR

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The effectiveness of Thromboelastography (TEG) or thromboelastometry (ROTEM)to guide transfusion treatment versus usual care in liver transplant. A eficácia da tromboelastografia (TEG) ou tromboelastometria (ROTEM) para orientar o tratamento transfusional versus o tratamento usual no transplante de fígado. La eficacia de la tromboelastografía (TEG) o tromboelastometría (ROTEM) para guiar el tratamiento de transfusión versus la atención habitual en el trasplante de hígado. ABSTRACTThe accuracy of the TEG/ROTEM as diagnostic test has been proved (19) and systematic reviews were performed to aggregate the evidence from different clinical scenarios (mainly cardiac surgery).Assess the impact of the intraoperative point of care use of TEG or ROTEM versus conventional coagulation tests (CCT) on the blood components transfusion, bleeding, complications, mortality, hospitalization and costs during adult LTX surgeries. I used PICOS framework to establish the research questions (objectives section) and the inclusion criteria. Type of studies included. The eligibility criteria were randomized controlled trials and non-randomized controlled trials (RCTs and non-RCTs).Primary outcomes: mortality at maximal follow up, allogeneic transfusion requirements: packaged red cells (PRC), platelets, fresh frozen plasma(FFP), cryoprecipitates), complications (medical adverse event that may be related to the coagulation status). Secondary outcomes: blood loss (however measured by authors), total hospital stays, intensive care unit (ICU) stay, costs (of the transplant surgery or of the patient in-hospital treatment). A total of 183 studies were identified and a PRISMAbased diagram was constructed and 8 of them were selected to assess. Six articles were found in full text and were screened for inclusion and exclusion criteria. Five trials had the selected outcomes and inclusion criteria and the quality was assessed with a critical appraisal approach to identify bias and confounders. In conclusion, TEG/ROTEM directed blood products replacement in LTX might be effective in reducing FFP transfusion during the intraoperative. Further studies are required to confirm this finding and to assess the overall requirements of other blood products, bleeding mortality and complications.

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A look into hemostatic characteristics during pediatric liver transplantation using the thromboelastometry (ROTEM®) test

Cho¹,

Moon

Song

et al. 2022

Liver Transplantation

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There is a paucity of evidence about the coagulation profile regarding the complexity of children undergoing liver transplantation (LT). This study aimed to investigate intraoperative hemostatic changes during pediatric LT according to the etiology for LT and examine the ability of rotational thromboelastometry (ROTEM®, TEM International GmbH, Munich, Germany) as a point‐of‐care monitoring method. We evaluated 106 patients aged 3 months to 17 years undergoing LT for acute liver failure (ALF) and chronic liver disease, which consists of patients with cholestatic disease, metabolic/genetic disease, and cancer. A total of 731 ROTEM® measurements, including 301 ellagic acid to initiate clotting via the intrinsic pathway, 172 tissue factor to initiate the extrinsic clotting cascade (EXTEM), and 258 cytochalasin D to inhibit platelet activity reflecting fibrinogen (FIBTEM), were analyzed at predetermined time points (the preanhepatic, anhepatic, and postreperfusion phases). We simultaneously conducted conventional coagulation tests. In children with ALF, preanhepatic measurements of conventional coagulation tests and ROTEM® showed a more hypocoagulable state than other diseases. During LT, the coagulation profile was deranged, with a prolonged clotting time and reduced clot firmness, changes that were more profound in the cholestatic disease group. Maximum clot firmness (MCF) on EXTEM and FIBTEM were well correlated with the platelet count and fibrinogen concentration (r = 0.830, p < 0.001 and r = 0.739, p < 0.001, respectively). On the EXTEM, MCF with 30 mm predicted a platelet count <30,000/mm3 (area under the curve, 0.985), and 6 mm predicted a fibrinogen concentration <100 mg/dl on the FIBTEM (area under the curve, 0.876). However, the activated partial thromboplastin time and prothrombin time were significant but only weakly correlated with the clotting time on the ROTEM®. In children undergoing LT, coagulation profiles depend on the etiology for LT. During LT, ROTEM® parameters could help detect thrombocytopenia and hypofibrinogenemia and guide transfusion therapy as a point‐of‐care monitoring method.

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The impact of thromboelastography on resuscitation in pediatric liver transplantation

Cited by 13 publications

References 14 publications

Trends in transfusion practice over 20 years in paediatric liver transplant programme

Trends in transfusion practice over 20 years in paediatric liver transplant programme

The effectiveness of Thromboelastography (TEG) or thromboelastometry (ROTEM) to guide transfusion treatment versus usual care in liver transplant.

A look into hemostatic characteristics during pediatric liver transplantation using the thromboelastometry (ROTEM®) test

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