Evaluation of Heparin Effects in Liver Transplantation Using Heparinase-Guided Thromboelastogram

Lee, Jae Min; Kim, Tae Hyun; Kim, Seong Nyun; Kim, Young Hoon; Choi, Jong Ho

Abstract

BACKGROUND
Complex coagulopathy during liver transplantation is influenced by many factors. A thromboelastogram (TEG) provides rapid information concerning coagulopathy and provides an aid for treatment. Heparin has been reported of a transplanted liver influence the pathogenic status of coagulation after reperfusion. Heparinase-guided TEG (hgTEG) can be easily used to determine the effects of heparin by comparing it with native TEG (nTEG), and provide a guide of the effect of heparin treatment.
METHODS
We evaluated the effects of heparin before and after reperfusion during liver transplantation, using nTEG and hgTEG. Seventy three patients underwent liver transplantation during the study period. They were evaluated for the effect of heparin after anesthetic induction and divided into two groups according to the presence (Heparin Group) or the absence (Non-heparin Group) of heparin induced effects. The presence of heparin effects were defined as a difference of over 20% in the coagulation time (r + k) on both TEGs, and an TEG beyond the normal range. Duration of the effect of heparin was defined up to the time when the normal nTEG index range was reached or when the difference in coagulation time using of the TEGs was < 20%. All patients were placed under general anesthesia and managed with routine supportive measurement including Rapid Infusion System (RIS). Both nTEG and hgTEG were measured after anesthetic induction and 10, 60, 120, 180, 240 and 300 minutes after reperfusion.
RESULTS
The results were as follows; Incidence of heparin effects before reperfusion was 27.4%. Heparin effects after reperfusion were prolonged in the Heparin Group versus the Non-heparin Group, but without statistical significance. Blood products in the two groups were not significantly different.
CONCLUSIONS
Heparin effects before reperfusion were not found to be correlated with heparin effects after reperfusion or with the amounts of transfused blood products. According to these results, we speculate that the two effects of heparin have separate roles in liver transplantation.