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Fibrinogen: A Clinical Update on Liver Transplantation
1Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, IDIBELL, Barcelona, Spain.
Transplantation Proceedings
|December 29, 2015
Summary
Liver transplant patients often have low fibrinogen levels, increasing bleeding risk. Timely fibrinogen replacement, guided by thromboelastometry, can improve surgical bleeding outcomes despite limited research.
Area of Science:
- Anesthesiology
- Hepatology
- Hematology
Background:
- Severe liver disease causes hemostatic and coagulation disorders, leading to significant bleeding during liver transplantation.
- Fluid resuscitation and fibrinolysis can worsen hypofibrinogenemia, a common issue in these patients.
- Existing criteria for fibrinogen replacement lack robust evidence, often relying on expert opinion.
Purpose of the Study:
- To review and update the criteria for fibrinogen replacement in liver transplantation.
- To synthesize current evidence regarding perioperative fibrinogen management in liver transplant recipients.
Main Methods:
- Conducted a systematic literature search of PubMed and Scopus databases (1990-2015).
- Keywords included: fibrinogen, liver transplantation, coagulation, and blood product replacement.
- Selected controlled trials and observational studies based on clinical relevance.
Main Results:
- A significant scarcity of controlled studies on perioperative fibrinogen replacement was identified.
- Empirical criteria for fibrinogen administration are common, with unestablished responses to cryoprecipitate or fibrinogen concentrate.
- Viscoelastic hemostatic assays show good correlation with plasma fibrinogen and can guide replacement therapy.
Conclusions:
- Low plasma fibrinogen levels are prevalent during liver transplantation, impacting surgical bleeding.
- Fibrinogen administration positively influences surgical bleeding, though literature is scarce.
- Fibrinogen replacement should aim for normal plasma levels and be guided by thromboelastometry.
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