studies

832A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Multivariate Model: WL Removal Death/Too Sick
Variables not significant: BMI, blood type, sex, dialysis, PVT,
prior abdominal surgery
Disclosures:
Norah Terrault - Advisory Committees or Review Panels: Eisai, Biotest; Consulting:
BMS, Merck, Achillion; Grant/Research Support: Eisai, Biotest, Vertex,
Gilead, AbbVie, Novartis, Merck
The following authors have nothing to disclose: Jeanne-Marie Giard
1260
Rotational Thromboelastometry (ROTEM) versus Conventional
Coagulation Tests during Orthotopic Liver Transplantation:
Comparison of Intra-operative Blood Loss,
Transfusion Requirements, and Cost
Laura Smart 1 , Danielle T. Scharpf 2 , Nicole O’Bleness Gray 1 ,
Daniel Traetow 2 , Sylvester Black 3 , Anthony Michaels 1 , Elmahdi
Elkhammas 3 , Robert B. Kirkpatrick 1 , Khalid Mumtaz 1 , A. James
Hanje 1 ; 1 Gastroenterology,Hepatology, and Nutrition, The Ohio
State University Medical Center, Columbus, OH; 2 Anesthesiology,
The Ohio State University Medical Center, Columbus, OH; 3 Transplant
Surgery, The Ohio State University Medical Center, Columbus,
OH
Purpose: Orthotopic liver transplantation (OLT) can be associated
with significant bleeding requiring multiple blood product
transfusions, especially in patients with severe liver dysfunction.
Rotational thromboelastometry (ROTEM) is a point-of-care
device that has been used successfully to monitor coagulation
on whole blood samples during OLT. Whether it reduces
blood loss and transfusions during OLT remains controversial.
Methods: ROTEM or conventional coagulation tests (activated
partial thromboplastin time (aPTT), prothrombin time (PT), international
normalized ratio (INR), platelet count, and fibrinogen)
were used to guide transfusion of platelets, cryoprecipitate,
and fresh frozen plasma (FFP) during OLT. 68 consecutive
patients were included in this non-randomized retrospective
study. 34 historic controls had transfusions guided by conventional
labs and 34 patients had transfusions guided by
ROTEM during OLT over 3 years. Patient characteristics as well
as pre- and post- transplant laboratory data were collected.
Intra-operative blood loss, type and amount of blood products
transfused, and cost were compared between the two groups.
Results: The ROTEM group had significantly less intra-operative
blood loss compared to the conventional group (2.0L vs 3.0L,
p=0.04). The total amount of blood products transfused was
less in the ROTEM group but did not reach statistical significance
(14.5 units vs. 17 units, p=0.11). Patients in the ROTEM
group received significantly less FFP (4 units vs. 6.5 units,
p=0.02) but more cryoprecipitate (2 units vs. 1 units, p=0.04).
Patient characteristics and pre-transplant laboratory results
were not statistically different between groups. Post-transplant,
both the INR and platelet count were significantly higher in the
ROTEM group (2.0 vs. 1.7, p=0.01 and 98,000 vs. 63,000,
p=0.002, respectively). The direct cost of blood products was
also less in the ROTEM group compared to the conventional
group ($103,786.09 vs $123,067.01). Conclusion: Implementation
of a ROTEM-guided transfusion algorithm resulted
in a reduction in intra-operative blood loss and a trend toward
decreased total blood product usage with resultant decrease in
cost during orthotopic liver transplantation.
Disclosures:
Anthony Michaels - Advisory Committees or Review Panels: Gilead, BMS, Janssen;
Speaking and Teaching: Gilead
A. James Hanje - Consulting: Salix pharmaceutical
The following authors have nothing to disclose: Laura Smart, Danielle T. Scharpf,
Nicole O’Bleness Gray, Daniel Traetow, Sylvester Black, Elmahdi Elkhammas,
Robert B. Kirkpatrick, Khalid Mumtaz
1261
Systolic Dysfunction Post-Liver Transplantation is associated
with Increased All-Cause Mortality
Michael Cheung 2 , She-Yan Wong 1 , Arun Mathew 3 , Dina Halegoua-De
Marzio 1 ; 1 Medicine, Division of Gastroenterology and
Hepatology, Thomas Jefferson University, Philadelphia, PA; 2 Medicine,
Division of Cardiology, Lankenau Medical Center, Philadelphia,
PA; 3 Medicine, Thomas Jefferson University Hospital,
Philadelphia, PA
Introduction Left ventricular systolic dysfunction has been
described after liver transplantation (LT), and is associated with
a critically ill status, high pre-transplant Model of End-Stage
Liver Disease (MELD) score and malnutrition. Previous studies of
this condition have reported a high likelihood of ejection fraction
recovery and survival at 1 year. The aim of this study was
to evaluate all-cause mortality of systolic dysfunction post-LT at
1 year and associated risk factors. Methods A retrospective
chart review from a single liver transplant center was completed
on all adult patients who received a liver transplant
between 1/2002 and 1/2015. Patients with systolic dysfunction,
defined as left ventricular ejection fraction (EF)