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Hemostasis in children undergoing liver transplantation
M Carlier1, L J Van Obbergh, F Veyckemans
1Department of Anesthesiology, Louvain Medical School, Brussels, Belgium.
Seminars in Thrombosis and Hemostasis
|January 1, 1993
Summary
Preoperative coagulation tests poorly predict intraoperative blood loss in pediatric liver transplants. Underlying liver disease etiology and prior surgery are key factors influencing severe bleeding during these procedures.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Orthotopic liver transplantation (OLT) in children is complex.
- Intraoperative blood loss is a significant concern.
- Predicting bleeding risk preoperatively is crucial for patient management.
Purpose of the Study:
- To identify preoperative factors predicting intraoperative blood loss in pediatric OLT.
- To evaluate the utility of a coagulation abnormality score (CAS).
Main Methods:
- Retrospective review of 200 children undergoing 238 OLTs.
- Calculation of a CAS based on six preoperative coagulation tests.
- Analysis of blood transfusion volumes and correlation with preoperative factors.
Main Results:
- CAS was higher in fulminant hepatic failure (Fulm), post-necrotic cirrhosis (PNC), and retransplantation (ReTx) groups.
- No correlation between CAS and blood requirements across etiology groups.
- Children with biliary atresia and ReTx required more blood (>200 ml/kg) than those with PNC, Fulm, metabolic diseases, or Alagille/Byler syndrome (<140 ml/kg).
- Group 1 (biliary atresia, ReTx) had lower CAS and better prothrombin time (PT) than Group 2.
Conclusions:
- Preoperative coagulation tests are weak predictors of intraoperative bleeding in pediatric OLT.
- Liver disease etiology and prior abdominal surgery significantly impact bleeding risk.
- Pediatric OLT patients exhibit similar intraoperative hemostatic changes to adults.