Hyperfibrinolysis Detection During Liver Transplantation Using Viscoelastometry

End-stage liver disease induces a precarious hemostatic equilibrium, named rebalanced hemostasis. Liver transplantation additionally causes profound disturbances in the hemostatic balance. Hyperfibrinolysis poses a relevant impairment to the coagulation process during liver transplantation. During surgery, the hemostatic management is guided by viscoelastic monitoring systems. The aim of this prospective, observational study was to evaluate the incidence of hyperfibrinolysis during liver transplantation using different viscoelastic assays, namely an ecarin-based test and a tissue factor-based test.

Blood sampling was done at five measurement time points during liver transplantation (T1 induction of general anesthesia, T2 start of anhepatic phase, T3 end of anhepatic phase, T4 10 min after reperfusion, T5 end of surgery). Viscoelastic testing included ClotPro assays EX-test, FIB-test, AP-test, and ECA-test. Hyperfibrinolysis was defined as a maximum lysis of at least 15%. Lysis detection time (LDT) served as an indicator for the velocity of lysis, marking the time point when less than 85% of the clot are extant.

Thirty transplantation surgeries were included. A total of 150 viscoelastic measurements have been performed. The ECA-test detected hyperfibrinolysis significantly more often (31 [21%] vs. 22 [15%] out of 150, p = 0.039) and in a higher number of patients than the EX-test. The ECA-test revealed hyperfibrinolysis significantly earlier compared to the EX-test (median LDT 2100 s [1500/2900] vs. 3300 s [2400/3800], p < 0.001).

This study demonstrates higher sensitivity of the ecarin-test than the tissue-factor-test in monitoring hyperfibrinolysis, with more frequent and earlier detection of this coagulopathy.

German Clinical Trials Register: DRKS00032827.