Detection of early allograft dysfunction at 30 min of reperfusion in liver transplantation: An intraoperative diagnostic tool with real time assessment of graft function

Hunter B. Moore, Hillary Yaffe, James J. Pomposelli, Michael Wachs, Thomas Bak, Peter Kennealey, Kendra Conzen, Megan Adams, Thomas Pshak, Rashikh Choudhury, Carson Walker, Alexander Schulick, Tanner Ferrell, Michael P. Chapman, Elizabeth A. Pomfret, Trevor L. Nydam

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: During the anhepatic phase of liver transplantation (LT), fibrinolytic activity increases, since the liver clears tissue plasminogen activator (tPA). We hypothesize that patients who fail to reduce fibrinolytic activity following graft reperfusion will have an increased rate of early allograft dysfunction (EAD). Methods: Assessment of fibrinolysis in liver transplant recipients was quantified with thrombelastography (TEG) LY30. Changes in LY30 were assessed after graft reperfusion. The 30-min post-reperfusion LY30 was subtracted from the anhepatic LY30 quantifying fibrinolytic changes (delta-LY30). Results: Seventy-three primary LT patients were included in the analysis. Receiver operating characteristic curve (ROC) analysis identified an inflection point of delta-LY30–5.3% as a risk factor for EAD. EAD occurred in 44% of these patients compared to 5% in high delta-LY30 (p = 0.002). Conclusion: LT recipients that develop hyperfibrinolysis who fail to reduce fibrinolytic activity 30 min after graft reperfusion had an EAD rate 8-fold higher than patients who had a large reduction in LY30 following reperfusion.

Original languageEnglish (US)
Pages (from-to)1518-1525
Number of pages8
JournalAmerican Journal of Surgery
Volume220
Issue number6
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Early allograft dysfunction
  • Fibrinolysis
  • Liver transplantation
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Surgery

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