Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction

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DOI: http://dx.doi.org/10.21454/rjaic.7518.252.tms

Dana Tomescu1,2, Mihai Popescu1,2, Simona Olimpia Dima3

1 Fundeni Clinical Institute, Department of Anaesthesia and Critical Care, Bucharest, Romania
2 “Carol Davila” University of Medicine and Pharmacy, Department of Anaesthesia and Critical Care
3 Fundeni Clinical Institute, “Dan Setlacec” Center for General Surgery and Liver Transplantation, Bucharest, Romania

Early allograft dysfunction (EAD) represents one of the most common and serious complications after liver transplantation (LT).
Methods. One hundred sixty-four patients who underwent LT were prospectively included in the present study. Patient demographics, intraoperative blood loss and transfusion were recorded at the time of LT. Lactate levels were recorded during surgery and daily for the first 3 postoperative days. Standard and derived rotational thromboelastometry (ROTEM) parameters were recorded 24 hours after LT. EAD was diagnosed according to Nanashima criteria and post anaesthesia care unit length of stay was recorded.
Results. Forty-seven patients (28.6%) developed EAD. Intraoperative blood loss (p = 0.01), packed red blood cells (p = 0.04) and fresh frozen plasma (p = 0.01) transfusion represented intraoperative risk factors for EAD. Lactate levels were significantly higher in patients with EAD at all time points. Patients with EAD demonstrated an increased clot formation time and decreased maximum clot firmness in both intrinsically (p < 0.01) and extrinsically (p < 0.01) activated assay, a decreased thrombin potential index (p
< 0.01), area under the curve (p < 0.01) and clot elasticity (p < 0.01) on ROTEM assay.
Conclusion. Our results show that both standard and derived ROTEM parameters may indicate early signs of graft failure and can aid in the diagnosis of EAD.
Keywords: liver transplantation, coagulation, rotational thromboelastometry, early allograft dysfunction