Utility of Thromboelastography in Guiding Blood Product Resuscitation During Liver Transplantation

Sarka Rusnak; B. Matuska; A. Weisz

doi:10.5281/zenodo.22818757

Authors

Sarka Rusnak Department of Laboratory Hematology, Guadiana Institute of Hematologic Oncology Author https://orcid.org/6051-8350-0059-8008
B. Matuska Department of Cellular Therapy and Transplantation, Weser Center for Stem Cell and Marrow Sciences Author https://orcid.org/7487-2486-5890-3606
A. Weisz Department of Hematology, Guadiana Institute of Hematologic Oncology Author https://orcid.org/8838-4967-7931-0098

DOI:

https://doi.org/10.5281/zenodo.22818757

Keywords:

thromboelastography, rotational thromboelastometry, liver transplantation, coagulopathy, goal-directed transfusion

Abstract

Graphical abstract

Background: Coagulopathy in end-stage liver disease is a rebalanced, dynamic hemostatic state, not a simple deficiency, and standard coagulation tests correlate poorly with bleeding risk during liver transplantation.

Objective: To synthesize published evidence on thromboelastography and rotational thromboelastometry for guiding blood product resuscitation during liver transplantation.

Methods: Narrative synthesis of transplant-specific randomized trials, before-and-after algorithm studies, and mechanistic coagulation literature.

Findings: Viscoelastic assays track the clot physiology that drives surgical bleeding more closely than the INR, and goal-directed algorithms consistently reduce plasma, platelet and red-cell exposure without increasing bleeding complications, though certainty remains low to moderate.

Conclusions: Phase-anchored TEG or ROTEM sampling before incision, during the anhepatic phase, and after reperfusion supports blood product decisions on a timescale a delayed INR cannot match.

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