Background and Objectives: Patients undergoing liver transplantation (LT) often require increased blood product transfusion due to pre-existing coagulopathy and intraoperative fibrinolysis. Strategies to minimise intraoperative bleeding and subsequent blood product requirements include platelet transfusion and tranexamic acid (TXA). Prophylactic TXA administration has been shown to reduce bleeding and blood product requirements intraoperatively. However, its clinical use is still debated. The aim of this study was to report on a single-centre practice and analyse clinical characteristics and outcomes of LT recipients according to intraoperative treatment of TXA or platelet transfusion. Materials and Methods: This was a retrospective observational cohort study in which we reviewed 162 patients’ records. Characteristics, intraoperative requirement of blood products, postoperative development of thrombosis and outcomes were compared between patients without or with intraoperative TXA treatment and without or with platelet transfusion. Results: Intraoperative treatment of TXA and platelets was 53% and 57.40%, respectively. Patients who required intraoperative administration of TXA or platelet transfusion also required more transfusion of blood products. Neither TXA nor platelet transfusion were associated with increased postoperative development of hepatic artery and portal vein thrombosis, 90-day mortality or graft loss. There was a significant increase in the median length of intensive care unit (ICU) stay in those who received platelet transfusion only (2.00 vs. 3.00 days; p = 0.021). Time to extubate was significantly different in both those who required TXA and platelet transfusion intraoperatively. Conclusions: Our analysis indicates that LT recipients still required copious intraoperative transfusion of blood products, despite the use of intraoperative TXA and platelets. Our findings have important implications for current transfusion practice in LT recipients and may guide clinicians to act upon these findings, which will support global efforts to encourage a wider use of TXA to reduce transfusion requirements, including platelets.

BackgroundHypofibrinogenemia is commonly found in patients with end stage liver disease and may increase blood transfusion during liver transplantation. In this study, we aim to identify the impact of preoperative hypofibrinogenemia on blood products transfusion requirements during liver transplantation recipients performed with surgical vena cava preservation technique.MethodsThis retrospective cohort study included 123 patients who underwent liver transplantation with surgical vena cava preservation technique between January 2016 through December 2019 in a tertiary hospital in Saudi Arabia. The study population was divided into two groups based on preoperative fibrinogen levels: normal (>1.5 g/L) vs low (<1.5 g/L). The primary endpoint was total requirements of blood products transfused intraoperatively. Secondary endpoints were total length of intensive care unit (ICU) and hospital stay. Mann-Whitney U test was used to measure differences between groups and Spearman rank test was used for correlation analysis. ResultsForty (32.52%) patients out of 123 in the study had low (<1.5 g/L) fibrinogen level preoperatively. Preoperative hypofibrinogenemia was significantly associated with increased requirements of packed red blood cells, platelets, cryoprecipitates, fresh frozen plasma and fibrinogen concentrate. Correlation analysis showed that preoperative fibrinogen levels negatively and significantly correlated with intraoperative blood products requirements (P< 0.001). Hypofibrinogenemia was weakly associated with length of ICU stay (Median= 3 days [Q1, Q3: 2, 5.50] days compared to 2 days [2.00, 4.00] in normal group, P= 0.049. Length of hospital stay was approximately similar between both groups. ConclusionsLow preoperative levels of fibrinogen significantly correlate with increased blood products requirements during liver transplantation with surgical vena cava preservation technique. Guided by preoperative fibrinogen levels, this study proposes that correction of fibrinogen levels before liver transplantation may reduce the need for transfusion of larger amounts of blood products.