Correlation of early ROTEM parameters with conventional coagulation tests in patients with chronic liver disease undergoing liver transplant.

Background and Aims: Viscoelastic tests such as rotational thromboelastometry (ROTEM) provide a quick and holistic assessment of coagulation status to guide transfusion during liver transplant (LT). Conventional coagulation tests (CCTs) measure single parameters in isolation, and also the results are delayed hampering management of patients during surgery. We evaluated the correlation of early ROTEM-derived parameters with CCTs and also assessed the ability of ROTEM-derived parameters to predict thrombocytopaenia and hypofibrinogenaemia during LT in patients with end-stage liver disease (ESLD).

Methods: This retrospective study was carried out in 100 patients with decompensated ESLD undergoing LT. Correlation between CCTs and ROTEM parameters was analyzed. Receiver operating characteristic curves with area under the curve were used to determine the cut-off values of A5 andA10 on EXTEM and FIBTEM.

Results: The values of A5EXTEM and A10EXTEM highly correlated with fibrinogen levels and platelet count, whereas A5FIBTEM and A10FIBTEM correlated well with fibrinogen levels. A5EXTEM <21 mm and A10EXTEM <28 mm correlated with a platelet count <75,000 mm-3 , whereas A5EXTEM <18 mm and A10EXTEM <25 mm correlated with a platelet count <50,000 mm-3 . Fibrinogen levels <100 mg/dL better correlated with A5FIBTEM <5 mm, A10FIBTEM <6 mm, A5EXTEM <21 mm and A10EXTEM <30 mm.

Conclusion: Early ROTEM parameters A5 and A10 of both EXTEM and FIBTEM had an excellent correlation with thrombocytopaenia and hypofibrinogenaemia and may potentially guide early transfusion of relevant blood products during LT.