Introduction: Little data exists in the use of thromboelastography (TEG) in pediatric liver transplantation. In 2011 we implemented pre-transplant TEGs for patients listed for liver transplantation. We sought to examine if there were any correlations with preoperative hypercoagulable indicies on the TEG and postoperative thrombotic complications.

Methods: We performed a retrospective review of pediatric patients undergoing liver transplantation at Children's Mercy Hospital between 1/1/2008 and 10/31/2014. The preoperative TEGs were analyzed and categorized based on normal, hypercoagulable, or hypocoagulable patterns.

Results: 19 patients underwent liver transplantation after implementation of TEGs in liver transplant patients at our facility. Seventeen (n=17) patients received at least one preoperative TEG prior to transplantation. There were 4 that had a least 1 hypercoagulable TEG preoperatively. Four patients (23.5%) developed postoperative thrombotic complications. Three of the 4 hypercoagulable patients (75%) and 1 of the 13 normal/hypocoagulable patients (8%) developed a thrombotic graft complication in the portal vein and/or hepatic artery. All of the hypercoagulable patients had portal vein thrombosis with or without hepatic artery thrombosis and the 1 normal/hypocoagulable patient had hepatic artery thrombosis only. Despite emergent exploration, sustained vascular flow was not achieved, and therefore all 4 patients who developed thrombotic complications had liver retransplant.

Conclusion: Based upon these preliminary data, we have identified that a preoperative hypercoagulable TEG portends to thrombotic complications in pediatric liver transplant patients. Further studies are needed to explore perioperative management strategies for high risk patients to prevent the development of postoperative thrombotic complications based upon preoperative TEG studies.

CITATION INFORMATION: Curiel K, Wicklund B, Gonzalez K, Andrews W, Fioravanti V, Hendrickson R. The Use of Thromboelastography (TEG) in Preoperative Pediatric Liver Transplantation to Predict Postoperative Thrombotic Complications. Am J Transplant. 2016;16 (suppl 3).

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