Prophylactic Recombinant Factor VIIa for Preventing Massive Transfusion During Orthotopic Liver Transplantation

Area of Science:

• Hepatology
• Transplantation Surgery
• Hematology

Background:

• Recombinant activated factor VIIa (rFVIIa) is used to reduce transfusions in liver transplant patients.
• High-risk patients may benefit from prophylactic rFVIIa to prevent massive transfusions.

Purpose of the Study:

• To evaluate the effectiveness and risks of prophylactic rFVIIa in liver transplant recipients at high risk for massive transfusion.
• To determine if prophylactic rFVIIa impacts the incidence of massive transfusion and thromboembolic events.

Main Methods:

• Retrospective study of liver transplant recipients from 2012-2015.
• Propensity matching was used to compare patients receiving prophylactic rFVIIa with controls.
• Thromboembolic events were reviewed from medical records.

Main Results:

• Prophylactic rFVIIa did not significantly affect the incidence of massive transfusion (60.5% vs 61.8%).
• No significant difference in thromboembolic events was observed between groups (P > .99).
• Fatal thromboembolic events occurred in one patient in each group.

Conclusions:

• Prophylactic rFVIIa in high-risk liver transplant patients did not reduce massive transfusion rates.
• The lack of clinical benefit and potential for fatal thromboembolic events limit its prophylactic use.
• rFVIIa is not recommended for prophylactic use in liver transplant recipients at high risk for massive transfusion.