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. 2024 May 16;10(6):e1637.
doi: 10.1097/TXD.0000000000001637. eCollection 2024 Jun.

Four-factor Prothrombin Complex Concentrate During Liver Transplantation: A Retrospective Cohort Study

Jennifer Lee  1 , Andrea Rivero  1 , J Ross Renew  1 , Aaron Spaulding  2   3 , Shalmali Borkar  3 , Ian Mckenzie  1 , Kuki Davey  1 , Beth Ladlie  1
Affiliations

Four-factor Prothrombin Complex Concentrate During Liver Transplantation: A Retrospective Cohort Study

Jennifer Lee et al. Transplant Direct. .

Abstract

Background: Four-factor prothrombin complex concentrate (PCC) is a plasma product that contains factors II, VII, IX, X, protein C, and protein S. PCC can be used off-label to treat coagulopathy during orthotopic liver transplantation (OLT). However, its use comes with safety concerns regarding thrombosis. The purpose of our study is to determine the safety of PCC in OLT.

Methods: We conducted a retrospective cohort study of patients who received 4-factor PCC during OLT at our institution from January 1, 2018, to May 1, 2022, with a 1:1 match of 83 patients who received PCC and 83 patients who did not. We evaluated 30-d mortality, 1-y mortality, prevalence of thrombotic complications (portal vein thrombosis, deep venous thrombosis, myocardial infarction, and pulmonary embolus), and postoperative intensive care (ICU) length of stay (LOS).

Results: There was no significant difference in 30-d mortality (odds ratio [OR] 5; 95% confidence interval [CI], 0.58-42.8; P = 0.14), 1-y mortality (OR 3; 95% CI, 0.61-14.86; P = 0.18), or ICU LOS (OR -13.8; 95% CI, -39.2 to 11.6; P = 0.29). There was no increased incidence of thrombotic complications among patients receiving PCC 90 d after surgery, including portal vein thrombosis (OR 1.5; 95% CI, 0.42-5.32; P = 0.53), pulmonary embolus (OR 1; 95% CI, 0.14-7.1; P = 0.99), deep venous thrombosis (OR 0.67; 95% CI, 0.11-3.99; P = 0.66), and myocardial infarction (OR 1.67; 95% CI, 0.4-6.97; P = 0.48).

Conclusions: Although there was a statistically insignificant increase in mortality after PCC administration during OLT, we did not see a significant increase in perioperative complications, including thrombotic events and increased ICU LOS.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Selection of study population. 4F-PCC, 4-factor prothrombin complex concentrate.
FIGURE 2.
FIGURE 2.
Forest plot of mortality, thrombotic complications, and ICU length of stay. DVT, deep vein thrombosis; ICU, intensive care unit; MI, myocardial infarction; PE, pulmonary embolism; Post-op, postoperative; PVT, portal vein thrombosis; VTE, venous thromboembolism.
FIGURE 3.
FIGURE 3.
1 year post transplant survival curves. A, Kaplan-Meier overall survival curve. B, Survival curve up to 1 y. C, Cox proportional hazards model.
See this image and copyright information in PMC

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