Background/Objectives: In chronic liver disease, a rebalanced coagulation state often
results in an increased risk of thrombosis, particularly in the splanchnic region.
While systemic coagulation abnormalities are well documented, alterations in regional
(portal) hemostasis remain underexplored. This study aimed to compare systemic and
portal hemostasis during liver transplantation and to determine whether systemic parameters
can accurately predict regional coagulation status. Methods: Thirty-five liver transplant
recipients were included in this study. Systemic blood samples (S1–S5) were collected
from the external jugular vein at five surgical time points, while portal blood samples
(R3) were obtained immediately before reperfusion simultaneously with S3. All samples
were analyzed using ClotPro® viscoelastic assays, conventional coagulation tests,
and blood gas analysis. Results: The EX-test comparison between S3 and R3 samples
revealed a discrepancy between systemic and regional hemostasis in 45.7% of patients.
Among these, eight regional samples exhibited hypocoagulation characterized by coagulation
factor consumption and hyperfibrinolysis. Another eight samples demonstrated hypercoagulation
with fibrinolytic shutdown, which was confirmed by a fibrin-rich thrombus identified
via scanning electron microscopy. Systemic samples failed to predict these regional
variations. Conclusions: Regional (portal) hemostasis significantly differs from systemic
coagulation and cannot be accurately predicted using systemic assays alone. These
findings suggest that fibrinolytic shutdown in the portal vein may contribute to intraoperative
and long-term graft damage, highlighting a potential need for regional coagulation
assessment during liver transplantation.
