• Antonio Leon-Justel, Jose A Noval-Padillo, Ana I Alvarez-Rios, Patricia Mellado, Miguel A Gomez-Bravo, Jose M Álamo, Manuel Porras, Lydia Barrero, Rafael Hinojosa, Magdalena Carmona, Angel Vilches-Arenas, and Juan M Guerrero.
• Laboratory Medicine Department, Huelva University Hospital (Institute of Biomedicine of Seville, Seville University), Spain. Electronic address: antonio.leonj.sspa@juntadeandalucia.es.
• Clin. Chim. Acta. 2015 Jun 15; 446: 277-83.

BackgroundOptimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT).MethodsWe performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups.ResultsTransfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2-8] to 3 [0-5] (p < 0.001), plasma from 2 [0-4] to 0 (p < 0.001), and platelets from 1 [0-4] to 0 [0-1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications.ConclusionsA haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.Copyright © 2015 Elsevier B.V. All rights reserved.

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