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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1541-1550
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1541
Hemostasis in liver transplantation: Pathophysiology, monitoring, and treatment
Matthias Hartmann, Cynthia Szalai, Fuat H Saner
Matthias Hartmann, Cynthia Szalai, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, D-45122 Essen, Germany
Fuat H Saner, Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, D-45122 Essen, Germany
Author contributions: Hartmann M wrote the manuscript; Szalai C and Saner FH discussed and corrected the manuscript.
Conflict-of-interest statement: Hartmann M and Saner FH have received honoria and funding for scientific lectures and retrospective data analyses from Behring GmbH, Marburg; Szalai C declares no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Matthias Hartmann, Professor, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Telephone: +49-201-7231402 Fax: +49-201-7235949
Received: April 27, 2015
Peer-review started: April 29, 2015
First decision: August 26, 2015
Revised: September 29, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 28, 2016
Core Tip

Core tip: Hemostasis in patients presenting for liver transplantation is often characterized by a reduction in both pro- and anticoagulant factors. During surgery, the rebalanced hemostasis system can be stressed by bleeding, hemodynamic shock, tissue damage or substitution of blood products with resultant diffuse bleeding or thrombus formation. Thrombelastography/thrombelastometry can guide substitution of blood products and reduces bleeding, transfusion of blood products, and eventual mortality. It is, however, important to state that bed-side methods are not capable of detecting alterations in anticoagulant pathways. Thus cautious coagulation management is recommended to avoid potential devastating thrombotic complications.