Thromboelastography in orthotopic liver transplantation

Concha T. Lawand, Rafael Buigas, William Devine, Hamid Nourmand, Anthony Gyamfi, Gunther Rincon

Research output: Contribution to journalArticle

Abstract

Introduction: Thromboelastography (TEG) is a functional, global indicator of whole blood coagulation capacity. TEG has been validated in the field of orthotopic liver transplantation (OLT). Patterns of TEG during the four stages of OLT and correction guidelines of abnormal parameters have been published. Methods: Over 2800 TEG recordings were retrospectively collected from over 600 OLT cases from 1994 through 1998. Patient pre-, intra- and postoperative variables, together with procedural data were also recorded. Correlation of TEG data with traditional coagulation parameters was done. Non-parametric analysis was used to determine significant patterns of coagulopathy in the population and associate them to other variables. Results: For all samples, prothrombin time (PT) and fibrin levels (F) correlated with coagulation time (K) and clot formation rate (alpha), while platelet count correlated with alpha and maximum amplitude (MA) (p<0.05). Renal failure and recipient age did not effect TEG recordings throughout the phases of surgery. Emergent nature of OLT was only associated with increased MA (p<0.05) in stage I. Use of veno-venous bypass during anhepatic stage did not lead to any difference in TEG parameters. The most significant variables associated to an abnormal TEG only on reperfusion were prolonged organ ischemic times (p<0.001): warm ischemic time was associated to a decreased alpha and increased clot lysis, while cold ischemic time lead to worsening of all the TEG parameters. Patients who developed MOSF and hepatic reperfusion injury postoperatively had significantly elevated levels of fibrinolysis postreperfusion (p<0.01). Fibrinolysis at baseline and increased K, with decreased MA and alpha on reperfusion was associated with increased ICU and hospital stay (p<0.05). Conclusions: OLT produces a severe, multifactorial coagulopathy detectable by TEG, in some aspects (fibrinolysis). better than conventional coagulation parameters. Increased coagulopathy in the form of fibrinolysis postreperfusion may indicate the quality of the donor organ and serve as a prognostic parameter.

Original languageEnglish (US)
Pages (from-to)A171
JournalCritical care medicine
Volume27
Issue number1 SUPPL.
StatePublished - Dec 1 1999

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Lawand, C. T., Buigas, R., Devine, W., Nourmand, H., Gyamfi, A., & Rincon, G. (1999). Thromboelastography in orthotopic liver transplantation. Critical care medicine, 27(1 SUPPL.), A171.