Intraoperative thromboelastography as a tool to predict postoperative thrombosis during liver transplantation

Table 1 Preoperative recipient characteristics, n (%)

Recipients characteristics		Case group (27 pts)	Control group (27 pts)	P value
Gender	Male	18 (67)	21 (77.7)	0.543
Age	yr	54 (44-62)	56 (49.7-62)	0.465
Cause of liver disease	Viral cirrhosis	7 (25.9)	5 (18.5)	> 0.999
	Alcoholic	5 (18.5)	5 (18.5)
	Cancer	12 (44.4)	14 (51.8)
	Cholestatic	3 (11.1)	3 (11.1)
First transplant	1	27 (100)	27 (100)
UNOS status	1	2 (7.4)	2 (7.4)	> 0.999
	2A	5 (18.5)	4 (14.8)
	2B	10 (37)	12 (44)
	3	10 (37)	9 (33)
Preoperative PVT		0	0	NA
INR		1.37 (1.27-2.34)	1.49 (1.10-1.85)	0.283
PLT	103/µL	81.5 (43.7-113.7)	88 (64.5-106.5)	0.488
Hb	mg/dL	11.4 ± 2.4	11.6 ± 2.1	0.746
Fibrinogen	mg/dL	237 ± 117	207 ± 99	0.314

All parameters were matched 1:1 when possible. UNOS: United Network for Organ Sharing; PVT: Preoperative portal vein thrombosis; INR: International normalized ratio; PLT: Platelet; Hb: Hemoglobin.

Table 2 Donor characteristics in the thrombosis group and control group

Donor and surgical-related characteristics		Case group (27 pts)	Control group (27 pts)	P value
Donor age	yr	54 (44-62)	56 (49-63)	0.465
Donor sex	Male	16	15	> 0.999
Donor BMI		24.9 ± 2.4	24.5 ± 3.1	0.598
CIT	min	410 ± 118	411 ± 123	0.976
WIT	min	38.4 ± 14	37.7 ± 16	0.865
Duration of surgery	h	390 ± 123	324 ± 95	0.032
Multiple arterial anastomoses or placement of an arterial interposition graft	n (%)	6 (18.5)	4 (14.8)	0.726

BMI: Body mass index; CIT: Cold ischemic time; WIT: Warm ischemic time.

Table 3 Intraoperative transfusion and number of patients transfused in the case group and control group

Intraoperative transfusion		Case group (27 pts)	Control group (27 pts)	P value
Patients transfused with RBC	n (%)	18 (66.3)	19 (70.3)	> 0.999
Homologous blood transfused	mL	990 (0-2239)	1320 (0-2350)	0.875
Autologous blood transfused	mL	742 (0-2041)	485 (0-1325)	0.566
PLT transfused	mL	0 (0-250)	0 (0-0)	0.152
Patients transfused with PLT	n (%)	9 (33.3)	7 (25.9)	0.766
FFP transfused	gr	400 (0-1000)	0 (0-1300)	0.965
Patients transfused with FFP	n (%)	12 (44.4)	12 (44.4)	0.784

RBC: Red blood cell; PLT: Platelets; FFP: Fresh frozen plasma.

Table 4 Thromboelastographic variables were statistically different during liver transplantation and between the two study groups

Thromboelastographic parameters		Case group (27 pts)	Control group (27 pts)	P value
R basal	min	26.8 ± 12.5	23.5 ± 12	0.327
K basal	min	13.2 (8.8-20.3)	10 (6.7-17.5)	0.200
α basal	degrees	17.3 ± 9.1	22 ± 11	0.093
MA basal	mm	39.5 ± 12.4	43.2 ± 12.7	0.284
Lysis 30’ basal	%	0 (0-0.1)	0 (0-0.1)	0.726
Lysis 60’ basal	%	1 (0-2.5)	0.7 (0-4)	0.881
G parameter basal	dyne/cm2	3661 (2342-4228)	2061 (1787-3122)	0.001
R 120’postrep	min	18.4 ± 8	16.8 ± 5.9	0.407
K 120’ postrep	min	7.9 (5.05-9.05)	7.9 (6.5-11.1)	0.638
α 120’ postrep	degrees	27.5 ± 10.8	27 ± 11.7	0.871
MA 120’ postrep	mm	36. 8 ± 12.6	37.6 ± 11.7	0.810
Lysis 30’ 120 postrep	%	0 (0.0-0.0)	0 (0.0-0.0)	0.107
Lysis 60’ 120 postrep	%	0.0 (0.0-1.9)	0.5 (0.3-5.5)	0.035
G parameter postrep	dyne/cm2	4502 ± 2914	2078 ± 1528	< 0.001

Table 5 Distributions of normal and abnormal thromboelastography parameters at different times during the observation period, n (%)

Thromboelastographicparameterss		Basal control	Basal cases	P value	120 Post-rip control	120 Post-rip cases	P value
R basal	Minor	4 (14)	1 (4)	0.371	4 (14)	5 (18)	0.099
	Major	7 (26)	8 (30)		1 (4)	6 (22)
	Normal	16 (60)	18 (66)		22 (82)	16 (60)
MA basal	Minor	13 (48)	17 (63)	0.420	20 (74)	19 (70)	0.950
	Major	3 (11)	1 (4)		1 (4)	1 (4)
	Normal	11 (41)	9 (33)		6 (22)	7 (26)
Lysis 60’ basal	FS	13 (48)	15 (56)	0.445	15 (55)	23 (85)	0.043
	Hyper	5 (19)	7 (26)		7 (26)	1 (4)
	Physiol	9 (33)	5 (18)		5 (19)	3 (11)

FS: Fibrinolysis shutdown.