Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study

Area of Science:

• Hepatology
• Transplantation Surgery
• Hematology

Background:

• Liver transplantation (LT) is a complex procedure with significant bleeding risks.
• Perioperative bleeding and transfusion management in LT can be improved with point-of-care monitoring.
• Quantra®, a sonorheometry-based device, assesses whole blood clot formation.

Purpose of the Study:

• To characterize Quantra® parameters during LT procedures.
• To evaluate correlations between Quantra® measurements and standard laboratory coagulation tests.
• To establish Quantra® cut-off values for key hemostatic abnormalities like thrombocytopenia, hypofibrinogenemia, and coagulation factor deficiencies.

Main Methods:

• 34 patients undergoing LT were enrolled.
• Blood samples were collected at three critical time points: pre-incision, during the anhepatic phase, and post-reperfusion.
• Quantra® parameters were analyzed and compared with standard coagulation assays.

Main Results:

• Clotting time (CT) showed strong correlation with prothrombin ratio (PT) and activated partial thromboplastin time (aPTT) ratio.
• Platelet contribution to clot stiffness (PCS) correlated significantly with platelet count (ρ = 0.82).
• Fibrinogen contribution to clot stiffness (FCS) correlated with fibrinogen levels (ρ = 0.74).
• Quantra® demonstrated high accuracy (AUC > 0.86) in predicting thrombocytopenia, hypofibrinogenemia, and PT/aPTT abnormalities.

Conclusions:

• Quantra® offers a rapid and reliable method for assessing hemostasis during liver transplantation.
• The device's parameters correlate well with established laboratory tests, facilitating real-time clinical decision-making.
• Quantra® can effectively identify critical hemostatic derangements in LT patients.