04 / When do we use blood products for coagulation management after liver transplantation

Tleuberdi Kuandykov

2018

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DOI 10.26226/morressier.5aeb0acc07b0d6001a79ab99
Data confidence 70 medium
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Abstract

Background and Goal of Study: end stage liver disease is associated with severe coagulation impairment, and optimal coagulation management remains one of the greatest challenges in liver transplantation. Recently restricted transfusion strategy become common in many transplant centers, this allowed to avoid many unnecessary transfusions (1). But some patients after liver transplantation still need active replacement of coagulation factors due number of reasons (2).Aim of study: to specify conditions when fresh frozen plasma (FFP) or cryoprecipitate transfusion are used in patients after liver transplantation.Materials and Methods: we studied retrospectively 87 adult patients with liver cirrhosis, aged 38.2u00b117.3 (24-60) yo, weight 65.8u00b17.9 (48-78) kg underwent liver transplantation. We studied activated partial prothrombine time (APPT), prothrombine time (PT), international normalized ratio (INR), level of serum fibrinogen A (FGA), platelets count (PLT), thromboelastography (K; R; u03b1 angle; MA; LY30), volume of FFP and cryoprecipitate transfused postoperatively.Results and Discussion: 12 (13.8%) of patients with MELD score 24.8u00b12.7 had severe coagulopathy and 8 (66.6%) of them had active bleeding, all of these patients were transfused FFP and/or cryoprecipitate. The coagulation tests showed significant prolongation of APPT and PT, decreased of FGA level, increased of INR and thromboelastography showed significant hypocoagulability.APPT 102.5u00b157.2 sec, PT 19.6u00b110.8%, INR 5.7u00b14.2, FGA 0.7u00b11.0 g/l, R 9.2u00b11.8 min, K 12.1u00b14.6 min, u03b1 angle 31.5u00b113.0 degree, MA 30.9u00b18.0 mm, LY30 0.1u00b10.3%.Mean volume of transfused FFP postoperatively was 3222.5u00b13274.8 (690-8650) ml. Transfused cryoprecipitate volume was 80u00b1193.7 (0-600) ml. FFP and cryoprecipitate transfusion was performed during 72h after surgery.Conclusion(s):13.8% of cirrhotic patients after liver transplantation presented severe coagulopathy and 66.6% of them had active bleeding.In case of active bleeding and severe coagulopathy (APPT 102 sec, PT 19.6%, INR 5.7, R 9.2 min, K 12.1 min, u03b1 angle 31.5 degree) FFP and/or cryoprecipitate might be transfused.