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Review
. 2023 May 29;12(11):3749.
doi: 10.3390/jcm12113749.

Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies

Giovanni Punzo  1 , Valeria Di Franco  1 , Valter Perilli  1   2 , Teresa Sacco  1   2 , Liliana Sollazzi  1   2 , Paola Aceto  1   2
Affiliations
Review

Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies

Giovanni Punzo et al. J Clin Med. .

Abstract

The risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27-2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy.

Keywords: blood transfusion; liver transplantation; meta-analysis; prothrombin complex concentrate; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plots reporting transfused units of RBCs, FFP, PLTs, and cryoprecipitate, respectively, (a–d) in PCC versus no PCC groups. The effect size is calculated as a mean difference (MD) and corresponding 95% confidence interval (95%CI) [4,5,6,7].
Figure 3
Figure 3
Forest plots reporting acute kidney injury (AKI), haemodialysis (HD), arterial thrombosis, respectively, (a–c) in PCC versus no PCC groups. The effect size is calculated as an odds ratio (OR) and corresponding 95% confidence interval (95%CI) [4,5,6,7].
Figure 4
Figure 4
Forest plots reporting intensive care unit (ICU) and hospital length of stay (LOS), respectively, (a,b) in PCC versus no PCC groups. The effect size is calculated as a mean difference (MD) and corresponding 95% confidence interval (95%CI) [5,7].
See this image and copyright information in PMC

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