Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 9, September, p. 1211–1215

doi: 10.17219/acem/69398

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Perioperative standards for the treatment of coagulation disorders and usage of blood products in patients undergoing liver transplantation used in the Clinic for Transplant Surgery in Wrocław

Marceli K. Łukaszewski1,A,B,C,D,E,F, Paweł Chudoba2,A,C,E, Agnieszka Lepiesza2,B, Marcin Rychter2,B, Piotr Szyber2,E,F

1 Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland

2 Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Poland


Background. Coagulation system disorders in liver transplantation (ltx) patients are considered a serious issue. Liver cirrhosis leads to decreased synthesis of clotting factors and decreased elimination of waste products, including coagulation proteins. Platelet sequestration and dysfunction in an enlarged spleen additionally worsen these conditions. The resulting state, the most common pathology of the coagulation system, involves the reduction of clotting potential and hyperfibrinolysis.
Objectives. Tackling the problem of impaired hemostasis is a dynamic process. Throughout the whole procedure, consisting of the preanhepatic, the anhepatic and the neohepatic phases, consecutive pathomechanisms disrupt the very balance that anesthesia aims to preserve.
Material and Methods. Rotational thromboelastometry (ROTEM), having been introduced in the Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland, enables the efficient and early diagnosis of clotting disorders. An additional major problem which occurs during ltx, namely blood loss, could be solved using a cell separator.
Results. In this study, we present the standards introduced to the Transplantology Department of the Vascular Surgery Clinic, Wroclaw Medical University, Poland, that describe blood treatment during ltx procedures.
Conclusion. We conclude that thromboelastometric examination and the use of a cell separator have significantly increased the safety of ltx procedures at our clinic. The introduction of thromboelastometry (TEM) and the implementation of the cell separator recovery method have enabled us to perform the dangerous and complicated surgical procedure of ltx in a much more stable and much safer manner than in the past.

Key words

point of care, thromboelastometry, cell separator, liver transplantation

References (10)

  1. Møller S, Henriksen HJ, Bendtsen F. Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects. World J Gastroenterol. 2014;20(42):15499–15517.
  2. Görlinger K. Coagulation management during liver transplantation [in German]. Hamostaseologie. 2006;26(Suppl 1):64–75.
  3. Hartog A, Mills G. Anaesthesia for hepatic resection surgery. Continuing Education in Anaesthesia, Critical Care & Pain. 2009;9(1):1–5.
  4. Feltracco P, Brezzi ML, Barbieri S. Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation. World J Hepatol. 2013;5(1):1−15
  5. Lier H, Vorweg M, Hanke A, Görlinger K. Thromboelastometry guided therapy of severe bleeding. Essener Runde Algorithm. Hemostaseologie. 2013;33(1):51–61.
  6. Ganter MT, Hofer CK. Coagulation monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106(5):1366–1375.
  7. Krzanicki D, Sugavanam A. Mallett S. Intraoperative hypercoagulability during liver transplantation as demonstrated by thromboelastography. Liver Transpl. 2013;19(8):852−861.
  8. Roullet S, Pillot J, Freyburger G, et al. Rotation thromboelastometry detect thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation. Br J Anaesth. 2010;104(4):422–428.
  9. Romero FA, Razonable RR. Infections in liver recipients. World J Hepatol. 2011;3(4):83–92.
  10. Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: An updated European guideline. Crit Care. 2013;17(2):R76.