الفهرس 
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Abstract
Haemostasis is usually monitored for liver transplant recipients during the immediate perioperative period but less often postoperative on surgical wards. The aim was to assess perioperative platelets function (PFT) and conventional coagulation testing (CCT), as well as the effect of prophylactic post-operative acetyl salicylic acid (ASA) and heparin on ROTEM.
After approval by the local research and ethical committee, this prospective observational trial was carried out on 40 consecutive recipients (PACTR 201803003217132) monitored by ROTEM platelet with citrated blood samples (ARATEM (AUC Normal Reference Range (RR) in Ohm∙min, 70-153), ADPTEM (RR: 38-113), TRAPTEM (RR: 61-156)), CCT, ROTEM (EXTEM, INTEM, FIBTEM, HEPTEM) perioperatively and on postoperative days (POD) 1, 3, 7, 14 and 21.
Blood transfusion was ROTEM-guided. Heparin was infused IV for 2 PODs at 60-180 U/kg/day, followed by LMWH (40 mg/24h) starting on POD 3. A heparin-like effect (HLE) was defined as CT INTEM >240 sec and INTEM/HEPTEM CT-ratio >1.25. Oral ASA (150mg/12h) started if platelet count >50,000 mm-3.
ROTEM platelet results were low preoperatively (AUC, median [IQR]: ADPTEM, 26.5[17.4-38.5] and TRAPTEM, 37[22.5-58] Ohm∙min) 74.5[61.5-91] Ohm∙min).
Platelets function on POD21 differentiated between non-survivors (10/40) and 3-month survivors (30/40), (TRAPTEM, 49[22-100] vs. 91[64-115] Ohm∙min, p=0.04), but recovered by POD 14 (ADAPTEM, 47[41.5-75.5] and TRAPTEM, 74.5[61.5-91] Ohm∙min).
Platelets count correlated with AUC ADPTEM and TRAPTEM (t=0.575, t=0.561, p=0.000). Both AUC ADPTEM and TRAPTEM correlated with MCF in EXTEM and INTEM (p=0.000). ASA was administered from POD7 in 25/40, on POD14 in 40/40 and on POD21 in 37/40 patients. ASA strongly decreased AUC ARATEM on POD7 and POD14 (6[3-8]), 6[3-9]) and POD21 (4[2-11] Ohm∙min). Three recipients showed hyper-reactivity in ADPTEM and/or TRAPTEM while on ASA.
HLE was observed on POD1 in 7/40 and on POD 3 in 2/40 patients during heparin infusion but not with LMWH. CCT and ROTEM significantly changed with transplant phases (p<0.05).
Significant correlations existed between ROTEM and CCT parameters (n=320), CT EXTEM and INR, =0.374, p=0.000, CT INTEM and aPTT, =0.435, p=0.000). Platelet count correlated with MCF in EXTEM (=0.547, p=0.000) and INTEM (=0.559, p=0.000).
RBCs were transfused in 27/40 patients (units, median [IQR], (4[2-3]), plasma in 15/40 (4[3-4]) and cryoprecipitate in 12/40 (12[12-12]). Partial hepatic artery or portal vein thrombosis was detected by Doppler in 2/40 and 1/40 patients, respectively, with no platelet hyperactivity.
All results were discussed .It was in agreement with some studies and in contrast with others. A special regimen of postoperative antiplatelets therapy and anticoagulants should be tailored for each patient.
In conclusion ROTEM platelet results prior to transplantation are low due to liver disease and thrombocytopenia. Platelet function recovers two weeks following transplantation but shows a significant decrease on POD21 in 3-months non-survivors. Platelets function tests with ROTEM platelet may be helpful to predict recovery and survival after transplantation and may be useful to guide postoperative antiplatelets therapy.