[Perioperative coagulation management in liver transplantation: a theoretical and practical exploration]

Objective: To investigate the characteristics of changes in coagulation function in different pathophysiological states during the preoperative, intraoperative, and postoperative phases of liver transplantation, along with its corresponding monitoring and clinical management strategies, and to provide our center's experience to other medical institutions. Methods: By reporting and analyzing the diagnosis and treatment process of a patient with secondary liver failure after hepatectomy in the perioperative period of liver transplantation, we summarize the characteristics of coagulation function in the perioperative period of liver transplantation as well as the management strategies, taking into account the consensus of relevant domestic and international guidelines. Results: In this case report, the pathophysiologic mechanisms of the different stages of perioperative liver transplantation differed significantly, and the corresponding changes in coagulation function were complex and difficult to measure. The coagulation characteristics of the perioperative stages can be summarized as preoperative platelet and coagulation factor deficiencies, intraoperative hypocoagulation and hyperfibrinolysis, postoperative incomplete recovery of coagulation function, and the coexistence of the risk of hemorrhage and thrombosis throughout the entire process, which should be treated with goal-oriented transfusion of blood products, anticoagulation, and antifibrinolysis, according to dynamic changes of the coagulation system, platelet counts, thrombus-related test indexes, and the overall function of the coagulation system such as the thromboelastogram. Under the premise of dynamic monitoring of relevant indicators, appropriate and moderate treatment should be given to maintain the relative homeostasis among the three systems of coagulation promotion, anticoagulation, and fibrinolysis, which not only avoids bleeding of vital organs caused by hypocoagulation, but also reduces the risk of perioperative thrombotic complications, and accurate monitoring and individualized treatment can improve the prognosis of the patients. Conclusion: Coagulation management in the perioperative period of liver transplantation is complex and variable, requiring enhanced monitoring and active and effective interventions. This study provides an important reference for the perioperative diagnosis and treatment of patients with end-stage liver disease and summarizes the effective management experience.