P034: FIBRINOLYSIS TRENDS IN DCD VS DBD LIVER TRANSPLANT. A 5-YEAR SINGLE CENTER RETROSPECTIVE STUDY
Eslam Fouda, MD; Fouad Souki, MD; Behrouz Ashrafi, MD; Gabriela Guanchez, MD; Massud Turbay, MD; Ramona Nicolau-Raducu, MD, PhD; Department of Anesthesiology, University of Miami, Jackson Memorial Hospital
Introduction/Background: Over the past ten years, there has been a steady rise in the use of donation after circulatory death (DCD) as a source for liver transplants in North America. Compared to donation after brain death (DBD), DCD organ procurement impose a mandatory longer warm ischemia time (WIT) in addition tissue plasminogen activators (tPA) flush to dissolve microthrombi in the biliary microcirculation. In this study we observed the differences between DCD and DBD liver transplants in terms of hyperfibrinolysis and its effects on blood products transfusion and outcomes.
Methods: Following IRB approval, we reviewed electronic medical records of adults who underwent a liver transplant at the University of Miami/Jackson Memorial Hospital from 2016-2020. We set to compare pre, intra, and postoperative variables in patients who received a liver from a DBD versus DCD. Exclusion criteria: combined transplants. Logistic regression identified the optimal threshold value (Jouden Index) for the MELD score which received DCDs and was matched with DBD of the same MELD. Categorical variables are presented as count and frequency (%), with differences between groups assessed using χ2 or Fisher’s tests as appropriate. Continuous variables are presented as median and range, with differences between groups assessed using the Wilcoxon rank-sum test.
Results: 270 patients were identified. 227 received DBD liver transplants, while 43 patients received DCD liver transplants. The optimal MELD score of <27 was identified to match the two group (Table 1). There was also a significant increase in the utilization of platelets and cryoprecipitate in the DCD group; however, there was no difference in total red blood cells (RBCs) or fresh frozen plasma (FFP) in both groups. The incidence of post reperfusion syndrome and the total usage of aminocaproic acid was also significantly higher in the DCD group. There was no difference in the post-operative complications such as hepatic artery thrombosis, acute kidney injury, or biliary complications (table.1). Patients who received DCD liver transplants had significant post-reperfusion hyperfibrinolysis compared to DBD (46.5 % vs 12.7 %, p <0.0001) (Fig.1).
Discussion/Conclusion: There is an increased incidence of post reperfusion syndrome and hyperfibrinolysis in DCD liver transplants. We believe that DCD organ procurement protocol and tPA flush influenced the post-reperfusion coagulopathy observed in this group. In the DCD group, more cryoprecipitate, and platelets transfusion in addition to aminocaproic acid were needed to treat coagulopathy after organ reperfusion. There was no difference in total blood transfusion requirements compared to the DBD group.