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Survey of hemostasis management and transfusion in liver transplantation
P Mellado1, I Benítez1, F Sánchez-Carrillo1
1Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España.
Insights
Management of haemostasis and transfusion practices in Spanish liver transplant centers show significant variability and a lack of standardized guidelines. Blood product use remains high, with limited adoption of advanced monitoring methods.
Area of Science:
- Hepatology
- Transplantation Medicine
- Anesthesiology
Background:
- Liver transplantation is a complex procedure requiring meticulous haemostasis and transfusion management.
- Current practices in Spain for managing bleeding and transfusions during liver transplants are not well-defined.
Purpose of the Study:
- To assess the current management of haemostasis and transfusion practices.
- To identify variations and potential areas for improvement in Spanish liver transplant centers.
Main Methods:
- A nationwide questionnaire survey was distributed to anesthesiology physicians at all Spanish liver transplant centers.
- Data collected covered the 12-month period from January 1 to December 31, 2011.
Main Results:
- Only 46% of centers had established protocols for haemostasis management.
- Significant variability existed in knowing transfusion data and patient satisfaction was low (50% dissatisfied).
- Limited use of thromboelastometry (8% preoperatively) and preoperative correction of coagulation deficits (46%).
Conclusions:
- Wide variability in haemostasis and transfusion practices exists across Spanish liver transplant centers.
- Lack of widely adopted guidelines contributes to inconsistent patient care.
- High transfusion rates persist, with a decline in the use of novel monitoring techniques.
Objective:
To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain.
Methods:
A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011.
Results:
Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient.
Conclusions:
There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring.
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