How Much Is the Inevitable Loss of Different Coagulation Factors During Blood Product - Free Liver Transplantations?

Background. Bloodless liver transplantations (LT) have already been reported, but special characteristics of hemostatic changes remain less defined. The aim of this study was to evaluate the "inevitable" loss of coagulation factors (CF) in blood product-free LT. Methods. Blood product and CF concentrate-free LT patient data were analyzed in terms of the first 2 days of perioperative hemostasis kinetics (N = 59). CF levels (FI, II, V, VII, X, and XIII), platelet (PLT) levels, and hemoglobin levels were measured before LT (T1), on arrival at the intensive care unit (T2), and 12, 24, and 48 hours after LT (T3, T4, and T5, respectively). Thromboelastographic (TEG) parameters were determined before and at the end of LT (T1-T2). Results. Fibrinogen levels decreased by 1.2 0.6 g/L, prothrombin levels by 26% +/- 14%, factor V levels by 40% +/- 23%, VII levels by 29% +/- 19%, and X levels by 39% +/- 22% (P < .001). From T2 to T4 fibrinogen increased by 0.9 +/- 0.6g/L for 24 hours (P < .001). Factor II, V, and VII levels increased by 20% +/- 16%, 31% +/- 32%, and 12% +/- 27%, respectively, between T3 and T5 (P < .001). However, factor X reached only half of the T1 level (T3-T5, P < .001). Platelet count increased in 34 (58%) patients at T2 (P < .001). The TEG parameters remained in the normal range during LT (T1-T2). Conclusion. The major findings of this study advocate that "inevitable" levels of CF decrease during LT by an average of 1.2 g/L in terms of fibrinogen and 23% to 40% regarding factors II, V, VII, and X. The authors suggest that knowing the "magic numbers" and comparing them against baseline laboratory results might predict the possibility of blood product-free transplant, providing confidence and safety to the surgeon and the anesthetist.