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Review
. 2023 Apr 4;11(4):1093.
doi: 10.3390/biomedicines11041093.

Patient Blood Management in Liver Transplant-A Concise Review

Angel Augusto Pérez-Calatayud  1 , Axel Hofmann  2   3 , Antonio Pérez-Ferrer  4   5 , Carla Escorza-Molina  6 , Bettina Torres-Pérez  7 , Jed Raful Zaccarias-Ezzat  8 , Aczel Sanchez-Cedillo  9 , Victor Manuel Paez-Zayas  10 , Raul Carrillo-Esper  11 , Klaus Görlinger  12   13
Affiliations
Review

Patient Blood Management in Liver Transplant-A Concise Review

Angel Augusto Pérez-Calatayud et al. Biomedicines. .

Abstract

Transfusion of blood products in orthotopic liver transplantation (OLT) significantly increases post-transplant morbidity and mortality and is associated with reduced graft survival. Based on these results, an active effort to prevent and minimize blood transfusion is required. Patient blood management is a revolutionary approach defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood while promoting patient safety and empowerment. This approach is based on three pillars of treatment: (1) detecting and correcting anemia and thrombocytopenia, (2) minimizing iatrogenic blood loss, detecting, and correcting coagulopathy, and (3) harnessing and increasing anemia tolerance. This review emphasizes the importance of the three-pillar nine-field matrix of patient blood management to improve patient outcomes in liver transplant recipients.

Keywords: adult and pediatric liver transplant; coagulation; patient blood management; viscoelastic testing.

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Conflict of interest statement

Angel Augusto Perez-Calatayud has received honoraria and travel support for consulting and lecturing from Vifor, Werfen, Takeda, Octapharma, and LFB. Axel Hofmann has received honoraria and/or travel support for consulting and lecturing from Celgene, G1Therapeutics, PBMe Solutions, South African National Blood Service, Takeda, Vifor, and Werfen. Klaus Görlinger is now the Medical Director of TEM Innovations/Werfen PBM, Munich, Germany. The rest of the authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The three-pillar nine-field matrix of patient blood management in liver transplant recipients.
Figure 2
Figure 2
A5EX: amplitude of clot firmness 5 min after coagulation time in EXTEM, CTFIB: coagulation time in FIBTEM (CTFIB > 600 s reflects a flat-line in FIBTEM). ML: maximum lysis (within one h run time), ACT: activated clotting time, CTIN: coagulation time in INTEM, CTHEP: coagulation time in HEPTEM, BW: body weight, A5FIB: amplitude of clot firmness 5 min after CT in FIBTEM, CTEX: coagulation time in EXTEM, PCC: prothrombin complex concentrate, FFP: fresh frozen plasma. LI60: Lysis Index (residual clot firmness in % of MCF) 60 min after CT, LI30: Lysis Index (residual clot firmness in % of MCF) 30 min after CT, IU: international units. AT: antithrombin, Cai2+: ionized calcium concentration, EACA: epsilon-aminocaproic acid, TXA: tranexamic acid, rFVIIa: activated recombinant factor VII. (Courtesy of Klaus Görlinger) Germany [62].
Figure 3
Figure 3
Timing of ROTEM analysis during orthotopic liver transplantation (OLT).
See this image and copyright information in PMC

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