PB1015 - Application of Thromboelastography in Pediatric Liver Transplantation: Insights from Mexican Patients. Instituto Nacional de Pediatria, Mexico City, Mexico

Background: Pediatric Liver Transplantation has evolved as the primary therapeutic choice for children facing end-stage liver disease. The integration of thromboelastography into perioperative management has markedly advanced overall survival and concurrently diminished the reliance on perioperative blood product transfusions.

Aims: Routine coagulation tests often reveal abnormalities in patients with cirrhosis, yet these only offer partial insights. ROTEM provides comprehensive, dynamic, and real-time information about hemostatic processes, covering everything from initial clot formation to strength, stability, platelet count, and activity.

Compared to conventional laboratory tests, ROTEM more accurately gauges bleeding risk, allowing for proactive measures to prevent and minimize blood transfusions during orthotopic liver transplantation. This is vital, as transfusing blood products during this procedure is associated with a significant increase in post-transplant morbidity and mortality. The nuanced insights provided by ROTEM offer a transformative approach, ensuring improved outcomes in pediatric liver transplantation

Methods: This study highlights the application of ROTEM as a perioperative tool in the initial six pediatric liver transplants at the National Institute of Pediatrics, a recently established reference center for such cases, that received cadaveric liver donor, routinary take ROTEM ( basal, during extraction, anhepatic phase, 30 min pos grafting).

Results: this patient received average 3 doses of fibrinogen during the surgery, one erythrocyte concentrate, just 1 patient receive one dose of CCP, nobody needed platelet transfusion. Iniciate infusion unfractionated heparin 6 to 8 hours after surgery.
as a routine measure AT3 once a week, fibrinogen, PT, APTT everyday

Conclusion(s): The world experience shows that fibrinogen is It's a pillar in management, CCP we used in patients with acute liver failure, and platelets we avoided during surgery time because are related to thrombosis graft.
The incorporation of rotational thromboelastometry (ROTEM) into liver transplant procedures reduces the need for blood products and facilitates swift coagulation status assessments, no thrombotic complications were observed.