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Semin Thromb Hemost 2023; 49(02): 119-133
DOI: 10.1055/s-0042-1758058
Review Article

Viscoelastic Management of Coagulopathy during the Perioperative Period of Liver Transplantation

Erin Stewart
1   Department of Anesthesia, University of Colorado School of Medicine, Aurora, Colorado
,
Trevor L. Nydam
2   Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
,
Adrian Hendrickse
1   Department of Anesthesia, University of Colorado School of Medicine, Aurora, Colorado
,
James J. Pomposelli
2   Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
,
Elizabeth A. Pomfret
2   Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
,
Hunter B. Moore
2   Division of Transplant Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
› Author Affiliations Funding This research was supported in part by the American Society of Transplant Surgeons Veloxis Fellowship Grant, National Heart Lung and Blood Institute Grant R00-HL151887.
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Abstract

Viscoelastic testing (VET) in liver transplantation (LT) has been used since its origin, in combination with standard laboratory testing (SLT). There are only a few, small, randomized controlled trials that demonstrated a reduction in transfusion rates using VET to guide coagulation management. Retrospective analyses contrasting VET to SLT have demonstrated mixed results, with a recent concern for overtreatment and the increase in postoperative thrombotic events. An oversight of many studies evaluating VET in LT is a single protocol that does not address the different phases of surgery, in addition to pre- and postoperative management. Furthermore, the coagulation spectrum of patients entering and exiting the operating room is diverse, as these patients can have varying anatomic and physiologic risk factors for thrombosis. A single transfusion strategy for all is short sighted. VET in combination with SLT creates the opportunity for personalized resuscitation in surgery which can address the many challenges in LT where patients are at a paradoxical risk for both life-threatening bleeding and clotting. With emerging data on the role of rebalanced coagulation in cirrhosis and hypercoagulability following LT, there are numerous potential roles in VET management of LT that have been unaddressed.

Keywords - liver transplantation - viscoelastic testing - transfusion


Publication History

Article published online:
01 November 2022

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