Real-time baseline coagulation profiles using ROTEM in patients undergoing liver transplantation
Real-time monitoring of blood coagulation during invasive surgeries is an important component of ensuring patient safety and effective treatment. Rotational thromboelastometry (ROTEM) is a viscoelastic monitoring system of hemostasis in blood that allows for ongoing measurement of global markers of coagulation. This study compares coagulation in a population of hepatocellular carcinoma liver-transplant patients (HCC) with a transplant population of other etiologies (non-HCC). A database of ROTEM measurements acquired peri-operatively during liver transplantation was compiled from over 400 Jefferson patients. A baseline profile was developed comprised of ROTEM measurements of clot initiation/stability that can be used as a methodological standard. Analysis was conducted to compare clot formation time in the HCC and non-HCC groups, and MELD (Model for End-Stage Liver Disease) score was used to assess association between liver coagulopathy diagnostic measures and ROTEM measurements. Preliminary analysis shows a trend towards ROTEM clotting time and MELD scores indicating less coagulopathy in the HCC population than the non-HCC group, though levels of variance were high. This could be explained by the focal nature of HCC lesions compared to other liver pathologies that are widespread throughout the parenchyma. Population-wide ROTEM clotting times had weak correlation with MELD scores to lend support to ROTEM measurement validity in assessing coagulopathy. Results indicate high variability in ROTEM coagulation measures for liver transplant patients regardless of hepatocellular carcinoma status, with some evidence at the group-level of HCC status being associated with less coagulopathy. Findings from this study can inform practice of hemostatic treatment in future transplantation procedures.
Del Prato, Paul and Yoon, MD, Uzung, "Real-time baseline coagulation profiles using ROTEM in patients undergoing liver transplantation" (2021). Phase 1. Paper 27.