Rotational thormboelastolmetry guided transfusion practice in living donor liver transplantation, A retrospective comparative study

Kandeel, Al-Refaey; Abdalla, Usama; Abouelella, Mohamed; Elmorshedi, Mohammed; Elsarraf, Waleed; Abdelwahab, Mohammed; Yassen, Amr

doi:10.1016/j.egja.2018.03.004

Rotational thormboelastolmetry guided transfusion practice in living donor liver transplantation, A retrospective comparative study

Authors

10.1016/j.egja.2018.03.004

Abstract

Introduction
Living donor liver transplantation (LDLT) is a complex surgery with high risk for massive bleeding and blood component transfusion. This retrospective study investigated the effect of adopting ROTEM based transfusion algorithm on blood products transfusion practice among LDLT recipients and the effect of this change on patient outcome.
Material and methods
Data of 216 patients with predicted intraoperative massive bleeding (blood loss ≥70 ml blood/kg, or blood loss >150 ml/min with hemodynamic affection with continuing need for transfusion) were collected from our database. Patients were divided into two groups according to transfusion protocol applied; Pre-ROTEM group (n = 95), ROTEM group (n = 121). Basal characteristics, blood component transfusion, graft outcome and patient outcome (28-day mortality and one-year mortality) were compared between the two groups.
Results
Transfused packed red blood cells (PRBCs) units, fresh frozen plasma (FFP) units, and application of massive transfusion protocol (MTP) were significantly lower in the ROTEM group compared to pre-ROTEM group [8(7) vs 4.5(5), p < 0.01, 12.5(4) vs 5.6(3), p < 0.001, 29% vs 20%, p < 0.005 respectively]. The survival distributions for the two studied groups showed no statistically significant difference, < 0.46.
Conclusions
ROTEM based transfusion algorithms applied in LDLT decreased blood component transfusion and enhanced early graft function.