Hyperfibrinolysis is a significant concern during liver transplantation surgeries. Rotational thromboelastometry (ROTEM) is a point of care device that is capable of intraoperatively measuring the clotting properties of whole blood samples, including the rate of fibrinolysis. The aim of this study was to use ROTEM to determine if improved surgical techniques have lowered rates of hyperfibrinolysis during liver transplantations. Blood samples were taken from 284 patients during liver transplantations that took place over five years from 2014-2019. The blood samples were drawn at various time points during the preanhepatic phase, anhepatic phase, and neohepatic phase of the surgery. Hyperfibrinolysis was defined using an accepted ROTEM definition of a maximum lysis value (ML) greater than 15%. Preliminary results show that 14% of patients experienced hyperfibrinolysis at some point during the surgery, which is similar to rates that previous studies have reported (p-values are currently unknown, as mentioned above). Preoperative MELD score, preoperative INR, and intraoperative clot strength do not appear to be related to hyperfibrinolysis. Both increased age, and non-alcohol related liver diseases (hemochromatosis, hepatocellular carcinoma, Hepatitis C etc.) as the reason for transplantation show higher rates of hyperfibrinolysis. The study suggests that hyperfibrinolysis remains a serious concern in liver transplantation surgeries, despite improvements in surgical technique. In addition, the study also suggests that non-alcohol related liver diseases and increased age are significant risk factors for hyperfibrinolysis that deserve special hematological attention.
Recommended CitationMadsen, Ryan; Yoon, Uzung; and Torjman, Marc, "Assessment of Hyperfibrinolysis in Liver Transplantation Surgery as Measured by Rotational Thromboelastometry" (2021). Phase 1. Paper 18.