Introduction: Thromboelastography (TEG) directs effective resuscitation in adult surgical and trauma patients. There is little data on TEG use in pediatrics. In 2011 we began employing TEG for pediatric liver transplantation (LT). We sought to examine the effect of TEG on fluid and blood product utilization and outcomes.

Methods: We performed a retrospective review of pediatric patients undergoing LT at a tertiary children's hospital between 2008-14. Patients who received a TEG during the operation or in the immediate postoperative course were compared to those who did not. Timing and frequency of TEG utilization was at the discretion of the treating physician. Data analyzed included demographics, diagnoses, laboratory values, fluid and blood product use and outcomes. Statistical analysis was performed using student paired T test.

Results: 38 patients underwent LT; 19 prior to implementation of TEG; and 19 with TEG performed during the perioperative period. The majority of patients underwent LT for biliary atresia (n=14), hepatoblastoma (n=7), and metabolic disorders (n=7). Demographics were similar between groups. Preoperative hemoglobin was lower in the TEG group (9.3 vs 10.7 gm/dl, p=0.04). Intraoperative blood loss, urine output, fluid and blood product use were similar between groups. However, the use of fresh frozen plasma (FFP) decreased significantly in TEG patients within the first 24 hours (4.6 vs 39.6 ml/kg, p<0.01), and between 24-48 hours (3.7 vs 23.1 ml/kg, p=0.01) postoperatively. The total use of FFP during hospitalization was markedly reduced (39.8 vs 153.9 ml/kg, p=0.02). There was no compensatory increase in platelets given in the TEG group. One patient in each group underwent reoperation for hemorrhage. Four patients in the TEG group had thromboembolic graft complications, including portal vein or hepatic artery thrombosis, and underwent retransplantation. A subset analysis of the TEG patients with thrombosis did not reveal any significant difference in fluid or blood products received.

Conclusion: The implementation of TEG in pediatric LT has led to substantially decreased use of FFP, an important finding for resource utilization and patient safety. The increased incidence of thromboembolic complications requires further investigation.

CITATION INFORMATION: Gonzalez K, Curiel K, Dalton B, Fioravanti V, Andrews W, Wicklund B, Hendrickson R. The Impact of Thromboelastography on Resuscitation in Pediatric Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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