Using Rotational Thromboelastometry to Identify Early Allograft Dysfunction after Living Donor Liver Transplantation

Area of Science:

• Transplantation Medicine
• Hepatology
• Coagulation Science

Background:

• Early allograft dysfunction (EAD) diagnosis after living donor liver transplantation (LDLT) lacks standardized methods.
• Rotational thromboelastometry (ROTEM) offers a dynamic assessment of hemostasis.

Purpose of the Study:

• To evaluate the predictive capability of ROTEM-derived parameters for EAD post-LDLT.
• To assess ROTEM's utility in conjunction with conventional criteria for EAD diagnosis and overall survival (OS) prediction.

Main Methods:

• Retrospective review of 121 LDLT patients.
• EAD defined by Olthoff criteria (bilirubin, INR, AST/ALT levels at postoperative day 7).
• ROTEM analysis, including extrinsically activated thromboelastometric test (EXTEM), performed pre- and 24-hours post-LDLT.

Main Results:

• Clotting time (CT) and time to maximum clot firmness (MCF-t) on EXTEM were independent predictors of EAD (p=0.026 and p=0.009, respectively).
• CT showed 82.0% specificity and 83.0% negative predictive value; MCF-t showed 76.4% specificity and 81.9% negative predictive value for EAD.
• Incorporating 24-hour post-LDLT ROTEM data improved the prediction of overall survival compared to Olthoff criteria alone (p < 0.001).

Conclusions:

• EXTEM-derived CT and MCF are independent predictors of EAD after LDLT.
• ROTEM analysis 24 hours post-LDLT, combined with conventional tests, aids in EAD diagnosis.
• This combined approach enhances the prediction of overall survival in LDLT recipients.