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Clinical Trial
. 2018 Jun 19;18(1):68.
doi: 10.1186/s12871-018-0536-2.

Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry

Kazuhiro Shirozu  1 , Naoyuki Fujimura  2 , Yuji Karashima  3 , Mizuko Ikeda  4 , Hidehisa Kitada  5 , Yasuhiro Okabe  5 , Kei Kurihara  5 , Tomoko Henzan  6 , Sumio Hoka  3
Affiliations
Clinical Trial

Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry

Kazuhiro Shirozu et al. BMC Anesthesiol. .

Abstract

Background: ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®).

Methods: Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCEplatelet, which represents platelet contribution to clot strength and where "MCE" stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM.

Results: The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCFEXTEM), MCFFIBTEM, and MCEplatelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCFEXTEM and MCEplatelet, and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCFEXTEM and MCEplatelet.

Conclusions: These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®.

Trial registration: UMIN-Clinical Trial Registry UMIN000018355 . Registered 21 July 2015.

Keywords: ABO-incompatible living-donor kidney transplantation; Plasma exchange therapy with albumin replacement fluid; ROTEM; Thromboelastometry.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the institutional clinical research ethics committee (IRB: Clinical Research number #26–286, Kyushu University, Fukuoka, Japan) and registered at UMIN-CTR (UMIN000018355). Informed consent was obtained from all participants included in this study.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
MCF and clotting time of EXTEM in the PEX group (red circles) and non-PEX group (blue circles). Data are presented as mean ± standard deviation. Sidak’s multiple-comparison post hoc test was utilized for two-way analysis of variance. ***p < 0.001
Fig. 2
Fig. 2
MCE of FIBTEM and the difference in the MCE between EXTEM and FIBTEM in the PEX group (n = 13, red circles) and non-PEX group (n = 15, blue circles). Data are presented as mean ± standard deviation. Sidak’s multiple-comparison post hoc test was utilized for two-way analysis of variance. **p < 0.01, ***p < 0.001
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