Viscoelastic versus conventional coagulation tests to reduce blood product transfusion in patients undergoing liver transplantation: A systematic review and meta-analysis.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
01 01 2023
01 01 2023
Historique:
pubmed:
23
11
2022
medline:
15
12
2022
entrez:
22
11
2022
Statut:
ppublish
Résumé
Recent literature suggests viscoelastic test (VET)-guided transfusion management could be associated with reduced blood product administration in patients undergoing liver transplantation. To assess the effectiveness of coagulation management guided by VETs compared with conventional coagulation tests (CCTs) in reducing blood product transfusion in patients undergoing liver transplantation. Systematic review and meta-analysis of randomised (RCTs) and nonrandomised clinical trials performed according to PRISMA guidelines. The protocol was previously published (PROSPERO: CRD42021230213). The Cochrane Central Library, PubMed/MEDLINE, Embase and the Transfusion Evidence Library were searched up to 30 th January 2022. Setting: operating room. Patients: liver transplantation recipients. Intervention: use of VETs versus CCTs. Main outcome measures: the primary outcome was the mean number of transfused units for each blood product including red blood cells (RBCs), fresh frozen plasma (FFP), platelets (PLTs) and cryoprecipitate. Secondary outcomes included mortality rate, intensive care unit (ICU) and hospital length of stay (LOS). Seventeen studies ( n = 5345 patients), 15 observational and two RCTs, were included in this review. There was a mean difference reduction in RBCs [mean difference: -1.40, 95% confidence interval (95% CI), -1.87 to -0.92; P < 0.001, I2 = 61%) and FFP units (mean difference: -2.98, 95% CI, -4.61 to -1.35; P = < 0.001; I2 = 98%) transfused in the VETs group compared with the CCTs one. A greater amount of cryoprecipitate was administered in the VETs group (mean difference: 2.71, 95% CI, 0.84 to 4.58; P = 0.005; I2 = 91%). There was no significant difference in the mean number of PLT units, mortality, hospital and ICU-LOS. Our meta-analysis demonstrated that VETs implementation was associated with reduced RBC and FFP consumption in liver transplantation patients without effects on mortality and hospital and ICU-LOS. The certainty of evidence ranged from moderate to very low. Further well conducted RCTs are needed to improve the certainty of evidence.
Sections du résumé
BACKGROUND
Recent literature suggests viscoelastic test (VET)-guided transfusion management could be associated with reduced blood product administration in patients undergoing liver transplantation.
OBJECTIVES
To assess the effectiveness of coagulation management guided by VETs compared with conventional coagulation tests (CCTs) in reducing blood product transfusion in patients undergoing liver transplantation.
DESIGN
Systematic review and meta-analysis of randomised (RCTs) and nonrandomised clinical trials performed according to PRISMA guidelines. The protocol was previously published (PROSPERO: CRD42021230213).
DATA SOURCES
The Cochrane Central Library, PubMed/MEDLINE, Embase and the Transfusion Evidence Library were searched up to 30 th January 2022.
ELIGIBILITY CRITERIA
Setting: operating room. Patients: liver transplantation recipients. Intervention: use of VETs versus CCTs. Main outcome measures: the primary outcome was the mean number of transfused units for each blood product including red blood cells (RBCs), fresh frozen plasma (FFP), platelets (PLTs) and cryoprecipitate. Secondary outcomes included mortality rate, intensive care unit (ICU) and hospital length of stay (LOS).
RESULTS
Seventeen studies ( n = 5345 patients), 15 observational and two RCTs, were included in this review. There was a mean difference reduction in RBCs [mean difference: -1.40, 95% confidence interval (95% CI), -1.87 to -0.92; P < 0.001, I2 = 61%) and FFP units (mean difference: -2.98, 95% CI, -4.61 to -1.35; P = < 0.001; I2 = 98%) transfused in the VETs group compared with the CCTs one. A greater amount of cryoprecipitate was administered in the VETs group (mean difference: 2.71, 95% CI, 0.84 to 4.58; P = 0.005; I2 = 91%). There was no significant difference in the mean number of PLT units, mortality, hospital and ICU-LOS.
CONCLUSION
Our meta-analysis demonstrated that VETs implementation was associated with reduced RBC and FFP consumption in liver transplantation patients without effects on mortality and hospital and ICU-LOS. The certainty of evidence ranged from moderate to very low. Further well conducted RCTs are needed to improve the certainty of evidence.
Identifiants
pubmed: 36412263
doi: 10.1097/EJA.0000000000001780
pii: 00003643-202301000-00006
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-53Informations de copyright
Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
Références
Ghinolfi D, Melandro F, Torri F, et al. Extended criteria grafts and emerging therapeutics strategy in liver transplantation. The unstable balance between damage and repair. Transplant Rev 2021; 35:100639.
Cata JP, Wang H, Gottumukkala V, et al. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth 2013; 110:690–701.
Teofili L, Valentini CG, Aceto P, et al. High intraoperative blood product requirements in liver transplantation: risk factors and impact on the outcome. Eur Rev Med Pharmacol Sci 2022; 26:64–75.
Sarani B, Dunkman WJ, Dean L, et al. Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit Care Med 2008; 36:1114–1118.
Gurusamy KS, Pissanou T, Pikhart H, et al. Methods to decrease blood loss and transfusion requirements for liver transplantation. Cochrane Database Syst Rev 2011; (12):CD009052.
Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol 2017; 34:332–395.
Caldwell SH, Hoffman M, Lisman T, et al. Coagulation in Liver Disease Group. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology 2006; 44:1039–1046.
Chee YL, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J 2003; 4:373–378.
Wikkelsø A, Wetterslev J, Møller AM, et al. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev 2016; (8):CD007871.
Meco M, Montisci A, Giustiniano E, et al. Viscoelastic blood tests use in adult cardiac surgery: meta-analysis, meta-regression, and trial sequential analysis. J Cardiothorac Vasc Anesth 2020; 34:119–127.
Veigas PV, Callum J, Rizoli S, et al. A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med 2016; 24:114.
Marsden NJ, Van M, Dean S, et al. Measuring coagulation in burns: an evidence-based systematic review. Scars Burn Heal 2017; 3:2059513117728201.
Kovalic AJ, Khan MA, Malaver D, et al. Thromboelastography versus standard coagulation testing in the assessment and reversal of coagulopathy among cirrhotics: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2020; 32:291–302.
Mallett SV. Clinical utility of viscoelastic tests of coagulation (TEG/ROTEM) in patients with liver disease and during liver transplantation. Semin Thromb Hemost 2015; 41:527–537.
Saner FH, Abeysundara L, Hartmann M, et al. Rational approach to transfusion in liver transplantation. Minerva Anestesiol 2018; 84:378–388.
Park SY. Viscoelastic coagulation test for liver transplantation. Anesth Pain Med (Seoul) 2020; 15:143–151.
Yoon U, Bartoszko J, Bezinover D, et al. ERAS4OLT.org Working Group. Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short-term outcomes after liver transplantation - a systematic review of the literature and expert panel recommendations. Clin Transplant 2022. e14637.
Malleeswaran S, Sivajothi S, Reddy MS. Viscoelastic monitoring in liver transplantation. Liver Transpl 2022; 28:1090–1102.
Sakai T. Viscoelastic testing in liver transplantation. Transfusion 2020; 60: (Suppl 6): S61–S69.
Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62:1006–1012.
McDiarmid SV, Anand R, Lindblad AS. Principal investigators and institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation 2002; 74:173–181.
Wells GA, Shea B, O’Connell D, et al . The Newcastle Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2011. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . [Accessed 1 March 2022]
Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed.Chichester: Wiley; 2019.
Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl 2003; 9:117–123.
Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14:135.
Weir CJ, Butcher I, Assi V, et al. Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review. BMC Med Res Methodol 2018; 18:25.
Peters JL, Sutton AJ, Jones DR, et al. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 2008; 61:991–996.
Kang YG, Martin DJ, Marquez J, et al. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation. Anesth Analg 1985; 61:888–896.
Wang SC, Shieh JF, Chang KY, et al. Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. TransplantProc 2010; 42:2590–2593.
Álamo JM, León A, Mellado P, et al. Is ‘intraeoperating room’ thromboelastometry useful in liver transplantation? A case-control study in 303 patients. Transplant Proc 2013; 45:3637–3639.
Leon-Justel A, Noval-Padillo JA, Alvarez-Rios AI, et al. Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome. Clin Chim Acta 2015; 446:277–283.
Roullet S, Freyburger G, Cruc M, et al. Management of bleeding and transfusion during liver transplantation before and after the introduction of a rotational thromboelastometry-based algorithm. Liver Transpl 2015; 21:169–179.
Smart L, Mumtaz K, Scharpf D, et al. Rotational thromboelastometry or conventional coagulation tests in liver transplantation: comparing blood loss, transfusions, and cost. Ann Hepatol 2017; 16:916–923.
Kandeel A, Abdalla U, Abouelella M, et al. Rotational thormboelastolmetry guided transfusion practice in living donor liver transplantation, a retrospective comparative study. Egypt J Anaesth 2018; 34:55–59.
Leon-Justel A, Alvarez-Rios AI, Noval-Padillo JA, et al. Point-of-care haemostasis monitoring during liver transplantation is cost effective. Clin Chem Lab Med 2019; 57:883–890.
Zamper R, Amorim T, Queiroz V, et al. Association between viscoelastic tests- guided therapy with synthetic factor concentrates and allogenic blood transfusion in liver transplantation: a before-after study. BMC Anesthesiology 2018; 18:198.
Bonnet A, Gilquin N, Steer N, et al. The use of a thromboelastometry-based algorithm reduces the need for blood product transfusion during orthotopic liver transplantation. Eur J Anaesthesiol 2019; 36:825–833.
Lekerika Royo N, Martinez Ruiz A, Arco Vázquez J, et al. Transfusional optimization in liver transplant using viscoelastic test guided therapy. Rev Esp Anestesiol Reanim 2020; 67:292–300.
Schumacher C, Eismann H, Sieg L, et al. Use of rotational thromboelastometry in liver transplantation is associated with reduced transfusion requirements. Exp Clin Transplant 2019; 17:222–230.
Nascimento J, Neto E, Silva E, et al. Analysis of the hemostatic therapy in liver transplantation guided by rotational thromboelastometry or conventional laboratory tests. Eur J Gastroenterol Hepatol 2019; 32:1452–1457.
Nguyen-Buckley C, Gao W, Agopian V, et al. Major thromboembolic complications in liver transplantation: the role of rotational thromboelastometry and cryoprecipitate transfusion. Transplantation 2020; 105:1771–1777.
Gaspari R, Teofili L, Aceto P, et al. Thromboelastography does not reduce transfusion requirements in liver transplantation: a propensity score-matched study. J Clin Anesth 2021; 69:110154.
Al Moosawi M, Trudeau J, Smith T, et al. ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion. Transfus Apher Sci 2021; 60:103125.
Scarlatescu E, Kietaibl SA, Tomescu DR. The effect of a viscoelastic-guided bleeding algorithm implementation on blood products use in adult liver transplant patients. A propensity score-matched before-after study. Transfus Apher Sci 2021; 61:103322.
Avolio AW, Gaspari R, Teofili L, et al. Postoperative respiratory failure in liver transplantation: risk factors and effect on prognosis. PLoS One 2019; 14:e0211678.
Fiorelli S, Biancofiore G, Feltracco P, et al. OLTx Study Group. Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study). Minerva Anestesiol 2022; 88:248–258.
Avolio AW, Franco A, Schlegel A, et al. Development and validation of a comprehensive model to estimate early allograft failure among patients requiring early liver retransplant. JAMA Surg 2020; 155:e204095.
Avolio AW, Agnes S, Chirico AS, et al. Primary dysfunction after liver transplantation: donor or recipient fault? Transplant Proc 1999; 31:434–436.
Bolliger D, Tanaka KA. Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery. Transfus Med Rev 2013; 27:213–220.
Ranucci M, Di Dedda U, Baryshnikova E. Trials and tribulations of viscoelastic-based determination of fibrinogen concentration. Anesth Analg 2020; 130:644–653.
Weber CF, Görlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012; 117:531–547.
Rodríguez-Castro KI, De Martin E, Gambato M, et al. Female gender in the setting of liver transplantation. World J Transplant 2014; 4:229–242.
Dumitrescu G, Januszkiewicz A, Ågren A, et al. Thromboelastometry: relation to the severity of liver cirrhosis in patients considered for liver transplantation. Medicine (Baltimore) 2017; 96:e7101.
Carll T, Wool GD. Basic principles of viscoelastic testing. Transfusion 2020; 60:S1–S9.