Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies.
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2023-03
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Abstract
Background
Hyperfibrinolysis is a possible complication during liver transplantation, particularly immediately after reperfusion.Methods
We performed a retrospective study to examine the incidence, treatment, and resolution of postreperfusion hyperfibrinolysis in patients undergoing liver transplantation at Duke University Hospital from 2015 to 2020.Results
Out of 535 patients undergoing liver transplantation, 21 or 3.9%, 95% CI (2.5-5.9), had hyperfibrinolysis after reperfusion. Hyperfibrinolysis occurred in 16 of 511 (3.1%) patients receiving livers from DBD donors, 5 of 18 (27.8%) patients receiving livers from donation after circulatory death (DCD) donors, and 0 of 6 (0.0%) patients receiving livers from living donors. Fibrinolysis was treated with cryoprecipitate (12/21), a combination of cryoprecipitate and tranexamic acid (3/21), or neither (6/21) and resolved within several hours in all cases.Conclusions
Anesthesiologists should be aware of the possibility of postreperfusion hyperfibrinolysis in liver transplantation, particularly with DCD donors, and may consider treatment with cryoprecipitate or tranexamic acid. Further work is needed to identify any potential differences, such as faster resolution of fibrinolysis, between different treatment modalities.Type
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Krom, Russell J, Ian J Welsby, Matthew Fuller, Andrew S Barbas, Qimeng Gao, Imran J Anwar and W Jonathan Dunkman (2023). Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies. Anesthesia and analgesia, 136(3). pp. 518–523. 10.1213/ane.0000000000006302 Retrieved from https://hdl.handle.net/10161/26664.
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Scholars@Duke
Ian James Welsby
As a practicing cardiothoracic anesthesiologist, I have contributed to the better understanding of the management and of perioperative thrombosis (particularly HIT). This has been as a Duke site PI for the Rare Thrombotic Diseases Consortium led by Dr T.L Ortel and a clinical collaborator with the basic and translational science approach to HIT led by Dr G Arepally. I have also championed novel approaches to dealing with perioperative HIT such as plasmaperesis.
Similarly, I have been a local leader in establishing management of transfusion approaches to major cardiac surgery including the novel introduction of autologous plateletpheresis to limit exposure to allogeneic platelet transfusions in this highly transfused population, identifying the transfusion requirements during thoracic aortic reconstruction and promoting use of a lower dose of rFVIIa use in this population, changing established clinical practice.
My research interests focus on perioperative transfusion and hematology concerns. Recently, Dr Kor (Mayo Clinic) and I received a multiple PI R-01 award to evaluate point-of-care/bedside washing of packed red blood cells to reduce perioperative lung injury. This novel repurposing of commonly available “cell-saver” technology is, for most surgical cases, the only practical means of delivering a washed product, and promises to be a critical advancement in perioperative transfusion medicine. I also have a longstanding interest in the rejuvenation of RBCs to normalize oxygen delivery capacity of transfused RBCs. Such a development will be of tremendous importance to transfusion practice, particularly for highly transfused populations and with current threats to blood banking inventory.
In summary, I have dedicated my research career to improving the outcome of patients undergoing cardiothoracic surgery, understanding perioperative coagulopathy, and optimizing transfusion practice.
Andrew Serghios Barbas
Imran Anwar
Jonathan Dunkman
I enjoy providing anesthesia for and taking care of a wide variety of complex patients in Duke University Hospital's main operating room and off site locations. After finishing residency at The University of Pennsylvania, I worked in private practice outside Philadelphia and completed a fellowship in cardiothoracic anesthesia here at Duke, all of which prepared me for the variety of complex surgeries and patients we care for in the operating rooms here at Duke. I also enjoy the research and education opportunities that come with working in this environment. I have specifically worked on our enhanced recovery after surgery (ERAS) programs and am currently the Director of Liver Transplant Anesthesia. I am engaged with a number of other operational roles including the Patient Safety and QI Committee, the Equipment Selection Committee and the Perioperative Leadership Group.
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