Using Rotational Thromboelastometry to Identify Early Allograft Dysfunction After Living Donor Liver Transplantation

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Aug 7

PMID 34362183

Authors

Chen-Fang Lee

Hao-Chien Hung

Wei-Chen Lee

Affiliations

Soon will be listed here.

Abstract

Background: Diagnostic tests for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) vary widely. We aimed to evaluate the predictive value of rotational thromboelastometry (ROTEM)-derived parameters in EAD.

Materials And Methods: A total of 121 patients were reviewed. The definition of EAD proposed by Olthoff et al. included the presence of any of the following at postoperative day 7: bilirubin level ≥ 10 mg/dL, INR ≥ 1.6, or serum AST or ALT levels > 2000 IU/L. All patients underwent ROTEM assay, which consisted of an extrinsically activated thromboelastometric test (EXTEM) before and 24 h after LDLT.

Results: The 1-year/2-year OS were 68.%8/64.5% and 94.4%/90.8% for the EAD and non-EAD groups, respectively ( = 0.001). Two independent risks were identified for EAD, the postoperative clotting time (CT, = 0.026) and time to maximum clot firmness (maximum clot firmness (MCF)-t, = 0.009) on the EXTEM. CT yielded a specificity of 82.0% and negative predictive value of 83.0%, and MCF-t displayed a specificity of 76.4% and negative predictive value of 81.9% in diagnosing EAD. The use of the 24 h post-LDLT ROTEM increased the effectiveness of predicting overall survival (OS) compared to using the Olthoff's EAD criteria alone ( < 0.001).

Conclusion: We conclude that CT and MCF on EXTEM were independent predictors of EAD. The 24 h post-LDLT ROTEM can be used with conventional laboratory tests to diagnose EAD. It increases the effectiveness of predicting OS.

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