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Impact of Intraoperative Coagulation Factor Concentrates during Pediatric Liver Transplantation: A Retrospective,
Mi Wang1, Fuquan Fang1, Yuhan Hu2
1Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Fibrinogen Concentrate (FibC) and Prothrombin Complex Concentrate (PCC) did not reduce Red Blood Cell (RBC) transfusions in pediatric liver transplantation patients. However, these coagulation factors did not increase the risk of thromboembolic complications.
Area of Science:
- Hepatology
- Transplantation Medicine
- Hematology
Background:
- Coagulopathy is a frequent complication in pediatric liver transplantation (LT), increasing morbidity and mortality.
- Limited research exists on the efficacy of Fibrinogen Concentrate (FibC) and Prothrombin Complex Concentrate (PCC) in pediatric LT.
- Bleeding management is critical during pediatric LT procedures.
Purpose of the Study:
- To evaluate the impact of FibC and PCC on Red Blood Cell (RBC) transfusion requirements in pediatric LT.
- To assess the safety profile of FibC and PCC in this patient population.
- To analyze the effect of these concentrates on intraoperative and postoperative bleeding.
Main Methods:
- A retrospective study of pediatric LT patients between March 2019 and December 2024.
- Patients receiving FibC and PCC were compared to a control group without these concentrates.
- Propensity score matching (1:1) was used to create comparable groups (n=118 each) for analysis.
Main Results:
- The FibC group (Group F) required significantly more RBC transfusions during surgery compared to the control group (Group C).
- Group F experienced increased bleeding and required tranexamic acid.
- No significant differences in postoperative drainage or RBC transfusion volumes were observed 24 hours post-surgery. Postoperative PT and INR were lower, while fibrinogen levels were higher in Group F. No thromboembolic events were noted.
Conclusions:
- Adjunctive use of FibC and PCC with FFP did not decrease transfusion needs in bleeding pediatric LT patients.
- FibC and PCC administration was not associated with an increased risk of thromboembolic complications.
- The clinical effectiveness of coagulation factor concentrates in pediatric LT is complex.
Introduction:
Coagulopathy is a common issue in pediatric Liver Transplantation (LT), and bleeding can lead to increased morbidity and mortality. However, there is limited research on the use of coagulation factor complexes, specifically Fibrinogen Concentrate (FibC) and Prothrombin Complex Concentrate (PCC), in pediatric LT.
Methods:
The study identified pediatric patients who underwent LT between March 2019 and December 2024. Patients who received FibC and PCC were categorized into the FibC group (Group F, n=150), while those who did not receive FibC and PCC were assigned to the control group (Group C, n=348). After 1:1 propensity score matching, 118 patients were included in each group for analysis. The primary endpoint was the need for Red Blood Cell (RBC) transfusion in pediatric patients undergoing LT.
Results:
The volume of RBC infusion during surgery was significantly higher in Group F compared to Group C, with a median [interquartile range] of 800.00 [600.00, 1000.00] ml for Group F versus 600.00 [400.00, 900.00] ml for Group C (p=0.004). During surgery, Group F experienced greater bleeding and required tranexamic acid. Furthermore, 24 hours after surgery, there was no significant difference between the two groups in terms of volume of intraperitoneal drainage or amount of RBC transfusion. The postoperative PT and INR levels in group F were significantly lower than those in group C, whereas fibrinogen levels were significantly elevated. There were no notable differences in postoperative complications, including embolism, between groups.
Discussion:
The factors affecting the clinical effectiveness of coagulation factor concentrates during pediatric liver transplantation are complex and multifaceted.
Conclusion:
This retrospective study indicated that the use of FibC and PCC as an adjunct to FFP did not lead to decreased transfusion requirements for children experiencing bleeding during liver transplantation. No thromboembolic complications related to FibC and PCC administration were noted.
