A simple intraoperative score incorporating thromboelastometric parameters predicts early reoperation for bleeding after liver transplantation

Early reoperation for bleeding after liver transplantation (ERBALT) is associated with increased morbidity and mortality. However, no reliable predictive tool is currently available. The primary aim was to evaluate the predictive ability of conventional coagulation tests and viscoelastic assays for identifying patients at risk of ERBALT within the first 7 days following liver transplantation (LT). A total of 275 patients who underwent LT at a tertiary center were screened in this prospective observational study. Conventional coagulation tests and viscoelastic assays were obtained at 4 time points: (1) postinduction, (2) end of the anhepatic phase, (3) 10 minutes after reperfusion (R10), and (4) 60 minutes after reperfusion (R60). Other recognized perioperative risk factors for ERBALT were recorded. A predictive score was developed based on the weighted coefficients from multivariable logistic regression. The final analysis included 222 patients, of whom 25 (11.26%) required ERBALT. These patients had more advanced liver disease (Child-Pugh score: 10 (8-11) vs. 8 (6-9), p =0.002) and required significantly higher volumes of fluids (4000 (3000-5750) mL vs. 3000 (2500-4000) mL, p =0.002) and blood products intraoperatively (80% vs. 51.3%, p =0.005). The score included R60-CTINTEM ≥230 seconds (4 points), R60-CT EXTEM ≥85 seconds (2 points); and intraoperative transfusion of ≥4 units of red blood cells (1 point) yielding a total score ranging from 0 to 7. Only 1% of patients with a score ≤3 required ERBALT, compared to 47.8% of those with a score of 7. The viscoelastic assay demonstrated strong predictive value for early reoperation for bleeding after LT. The proposed risk score could facilitate the timely correction of coagulation and potentially improve clinical outcomes after LT.