Hemostasis in Children with Chronic Liver Disease and Peri-liver Transplant Management

Hemostasis is significantly impaired in end-stage liver disease (ESLD), leading to frequent unexpected bleeding, thrombosis, or both, even with minimal irritation. Although conventional coagulation tests are insufficient to accurately assess the hemostasis state in cirrhosis, there is growing evidence of a delicate rebalance between procoagulants and anticoagulants in ESLD, with most patients maintaining a fragile yet relatively balanced state. While substantial data exist for adults, evidence guiding clinicians in managing coagulopathy in children with ESLD remains scarce. This review summarizes the pathophysiology of hemostasis in patients with ESLD, highlights the recent advances in children with ESLD, discusses the advantages and limitations of various laboratory tests for evaluating coagulopathy, and outlines the potential interventions for common clinical situations.