Update on Coagulation Monitoring in Liver Transplantation

Abstract

Purpose of Review This article provides an update on coagulation monitoring for patients undergoing liver transplantation and focuses on emerging data from the newest generation of viscoelastic testing devices. Recent Findings New generation, cartridge-based viscoelastic testing (VET) devices (TEG 6s, ROTEM sigma, Quantra with QStat cartridge) offer less inter-operator variability with greater ease of use and application at the point of care. Data on use of these cartridge-based VET devices in liver transplantation is limited. Summary The coagulopathy of liver disease affects both procoagulant and anticoagulant factors, resulting in a ‘rebalanced hemostasis’. The phases of liver transplantation present unique and dynamic challenges to blood management in these patients. VET is the preferred method of coagulation monitoring in liver transplantation with demonstrated benefits in decreased blood transfusion requirements, blood loss, and cost. Newer cartridge-based VET technologies have purported improvements over older technologies. More thorough investigation is needed in the use of these newer VET devices in liver transplantation.