Abstract: Introduction: During liver transplantation, haemostasis is typically assessed
by means of standard laboratory tests and viscoelastic tests, while dynamic monitoring
of coagulation factor specific blood losses is an unusual, yet established approach.
Aim: Our aim was to evaluate the volume-based haemostasis reserves in blood product
free liver transplants in the first perioperative 48 hours, in association with the
Child?Pugh score. Method: Data of 59 blood product free liver transplanted patients?
coagulation factor levels, viscoelastic parameters and coagulation factor specific
blood losses according to Gross methodological, baseline and ?coagulopathic? trigger
levels were analysed. The haemostasis reserves were estimated according to the Child?Pugh
classification. Laboratory tests and the calculation of haemostasis reserves were
carried out before liver transplantation (T1), at the end of the surgery (T2) and
also 12?24?48 hours postoperatively (T3?T4?T5). The viscoelastic tests were performed
before liver transplantation (T1) and at the end of the surgery (T2). Results: Fibrinogen
levels decreased by 1.2 g/L. Factor II, V, VII, X levels decreased by 26?40%. From
T2 to T4, fibrinogen increased by 0.9 ± 0.6 g/L over 24 h (p<0.001). Factor II, V,
VII, X levels increased by 12?30% between T3 to T5 (p<0.001). The viscoelastic parameters
remained in the normal range during liver transplantation (T1?T2). Haemostasis reserves
decreased by 61% at the end of surgery (p<0.001), but reached 88% of the preoperative
value on the second postoperative day. The initial reserves of Child B and C groups
were 36?41% lower than Child A, nevertheless, these differences were not significant
at 48 hours. Conclusion: The volume-based haemostasis approach supplements the standard
laboratory and viscoelastic tests. This unusual approach dynamically indicates the
actual reserve of haemostasis and shows the ?weakest link? within the system. Orv
Hetil. 2020; 161(7): 252?262.
