الفهرس 
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Abstract
Introduction: Hypercoagulability can lead to serious thromboembolic events.
Aim: is to assess the perioperative coagulation for recipients with tendency to hypercoagulability.
Patients and methods: A prospective diagnostic study includes 43 consecutive recipients. Three or more of the following were used as inclusion criteria (low Protein C, low Protein S, low Anti thrombin, abnormal Factor V Leiden mutation, increased lupus anticoagulant, increased Homocystein IgG-IgM, and increased antiphospholipid antibodies).
Rotational thromboelastometry (ROTEM) (EXTEM, INTEM and FIBTEM) and conventional coagulation tests (CCT) were assessed preoperative, anhepatic phase, post-reperfusion, and on first, third and seventh postoperative days. ROTEM was used to guide blood transfusion. Heparin infused (60-180 U/kg/day) postoperative for 3 days then replaced with low molecular weight heparin (20 mg/12 h).
Results: FIBTEM (MCF) significantly and steadily increased above reference range postoperatively despite normal fibrinogen blood levels (P<0.05).Both EXTEM and INTEM demonstrated significant changes with phases of transplantation (P<0.05), but with no hypercoagulation. INTEM CT (normal ref 100-240 sec) normalize on days 3 and 7 (199.58±73.55, 186.90±67.01), despite prolonged aPTT (normal ref 35-45 sec), (62.53±17.91, 48.49±15.79) respectively. No significant correlation was found between ROTEM and CCT. Hepatic artery thrombosis (HAT) reported in 5/43(11.62%) and portal vein thrombosis in 2/43 (4.65%), mainly after critical care discharge and with high FIBTEM (MCF) in 5/7. Blood units transfused (RBCs 8.80+5.82, FFPs 8.62+4.07 and Cryoprecipitate 12+4) with no postoperative requirements. One year survival was 74.5%.
Conclusion: A postoperative step ladder increase in FIBTEM MCF was observed despite normal fibrinogen blood levels. Extension of ROTEM beyond one week could help indentifying recipients at increased risk for thromboembolism when CCT fails to diagnose the condition. Ability of FIBTEM to be used as a predictor for thromboembolic events need to be investigated. A ROTEM guided anticoagulation regime need to be developed and investigated.