Rotation thromboelastometry velocity curve predicts blood loss during liver transplantation

Area of Science:

• Hepatology
• Transplantation Medicine
• Hemostasis and Thrombosis

Background:

• Liver transplantation (LT) is associated with a high risk of bleeding.
• Accurate prediction of blood loss (BL) is crucial for patient management.
• Rotation thromboelastometry (ROTEM) offers dynamic assessment of clot kinetics.

Purpose of the Study:

• To evaluate the predictive capability of the first derivative of the velocity waveform (V-curve) from ROTEM for blood loss during LT.
• To assess the V-curve's ability to discriminate between low and high blood loss groups.
• To analyze V-curve performance in subgroups based on cirrhosis etiology.

Main Methods:

• Retrospective analysis of preoperative V-curve parameters in 198 LT patients.
• Patients categorized into quartiles based on blood loss (low vs. high).
• Logistic regression and ROC curve analysis to determine V-curve discriminative capacity.

Main Results:

• High blood loss (HBL) group showed lower maximum velocity (MaxVel) and area under the curve (AUC), and higher time-to-maximum velocity (t-MaxVel).
• t-MaxVel was the sole V-curve parameter significantly discriminating between LBL and HBL (ROC area 0.69).
• Discriminative capacity was higher in patients with cirrhosis (ROC 0.78), viral hepatitis (0.73), and alcoholic hepatitis (0.83).

Conclusions:

• Pre-transplant V-curve analysis via ROTEM is a promising tool for predicting blood loss risk in LT.
• The V-curve, particularly t-MaxVel, demonstrates utility in identifying patients at higher risk of bleeding.
• This predictive capability is especially pronounced in patients with cirrhosis.