Monitoring and managing coagulation during liver transplantation poses significant challenges due to the intricate balance of procoagulation and anticoagulation factors. Thromboelastography (TEG) offers rapid, comprehensive, and accurate assessment, showing promise in guiding optimal coagulation management during liver transplantation. While TEG5000 devices have been extensively utilized and studied, the introduction of TEG6s in the 2010s has expanded possibilities for data collection and analysis in this field. However, in regions such as Japan, TEG adoption has been hindered by inadequate health insurance coverage. This report highlights cases of massive bleeding and intraoperative thrombotic complications, focusing on the potential contributions of TEG6s in improving coagulation management strategies. Findings suggest that TEG6s could offer valuable insights and aid in optimizing coagulation management in liver transplantation procedures.
In cases 1 through 3, significant challenges were encountered involving massive bleeding during and after liver transplantation. Case 1 involved the transplantation of a marginal graft with moderate macrosteatosis, resulting in substantial bleeding attributed to postreperfusion syndrome. Case 2 faced difficulties during hepatectomy due to a cocoon abdomen from multiple episodes of spontaneous bacterial peritonitis. In Case 3, hepatectomy was exceptionally challenging due to severe adhesions resulting from a prior Kasai operation, compounded by a precarious health status reflected by a MELD score of 40. TEG data from these cases of massive bleeding were meticulously analyzed to gain insights into their hemostatic profiles.
Cases 4 through 6 encountered notable intraoperative thrombotic complications during liver transplantation. Case 4 presented intraoperative portal vein thrombosis, necessitating thrombectomy and reanastomosis due to extreme hypercoagulability possibly attributed to primary sclerosing cholangitis. Case 5 experienced hepatic artery thrombosis prior to arterial anastomosis, requiring arterial thrombectomy employing a 4Fr Fogarty catheter. In Case 6, immediate post-reperfusion revealed right posterior portal vein thrombosis, prompting thrombectomy with temporary portal vein clamping. Post-liver transplantation, unfractionated heparin was administered. TEG data analysis from these cases provided valuable insights into the hemostatic profiles underlying intraoperative thrombotic complications.
A retrospective analysis of liver transplantations complicated by hemostatic issues was conducted, utilizing detailed data obtained from TEG6s analysis. Notably, in Japan, TEG analysis has not been widely embraced, necessitating the accumulation of TEG6s data to formulate an optimal transfusion protocol.