Maroun W, Osborn ZF, Garg P, Angappan S, El-Bashir J, Heppell O, Soetedjo J, Pillai S, Miyake K, Mohamed A, Nagai S, Guerra-Londono CE. Thromboelastographic description of intraoperative coagulopathy in patients undergoing liver transplant surgery: A single-center observational study. World J Transplant 2026; 16(2): 118880 [DOI: 10.5500/wjt.v16.i2.118880]
Corresponding Author of This Article
Carlos E Guerra-Londono, MD, Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Hospital, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, United States. cguerra1@hfhs.org
Research Domain of This Article
Anesthesiology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2026; 16(2): 118880 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118880
Thromboelastographic description of intraoperative coagulopathy in patients undergoing liver transplant surgery: A single-center observational study
Wissam Maroun, Zachary F Osborn, Paras Garg, Santhalakshmi Angappan, Jaber El-Bashir, Olivia Heppell, James Soetedjo, Srikanth Pillai, Katsunori Miyake, Adhnan Mohamed, Shunji Nagai, Carlos E Guerra-Londono
Wissam Maroun, Zachary F Osborn, Paras Garg, Santhalakshmi Angappan, Jaber El-Bashir, Olivia Heppell, James Soetedjo, Srikanth Pillai, Carlos E Guerra-Londono, Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Hospital, Henry Ford Health, Detroit, MI 48202, United States
Katsunori Miyake, Adhnan Mohamed, Shunji Nagai, Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Henry Ford Health, Detroit, MI 48202, United States
Author contributions: Maroun W wrote the initial draft; Maroun W, Osborn ZF, Garg P, Angappan S, El-Bashir J, Heppell O, Soetedjo J, Pillai S, Miyake K, Mohamed A, Nagai S, Guerra-Londono CE reviewed and edited the manuscript; Osborn ZF performed the statistical analysis; Heppell O, Soetedjo J, Pillai S, and Miyake K participated in data collection. All authors approved the final manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of Henry Ford Health (Approved No. 15528-01) and conformed to both the Declaration of Helsinki and Declaration of Istanbul ethical guidelines.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.
Corresponding author: Carlos E Guerra-Londono, MD, Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Hospital, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, United States. cguerra1@hfhs.org
Received: January 13, 2026 Revised: February 8, 2026 Accepted: March 13, 2026 Published online: June 18, 2026 Processing time: 136 Days and 15.4 Hours
Abstract
BACKGROUND
Patients undergoing liver transplantation often develop multiple hemostatic abnormalities requiring dynamic transfusion and antifibrinolytic support; however, how hemostatic status changes over time during liver transplant surgery is not well defined, limiting clinicians’ ability to anticipate and manage hemostatic instability.
AIM
To describe the distribution of intraoperative coagulation abnormalities across the surgical phases of liver transplantation.
METHODS
We conducted an observational study of adult patients who underwent liver transplantation at Henry Ford Health between January 2017 to April 2022. Intraoperative coagulation data from conventional coagulation tests and 2 thromboelastography (TEG) platforms (TEG 5000 and TEG 6s) were collected. Data were stratified across 4 surgical phases: Pre-anhepatic, anhepatic, post-reperfusion, and end-of-surgery.
RESULTS
Of 364 liver transplant recipients, coagulation abnormalities occurred during all surgical phases, with the highest frequency in the anhepatic and post-reperfusion phases. Platelet dysfunction was the most common abnormality, peaking during post-reperfusion, while hyperfibrinolysis was less frequent and resolved in most patients by the end of surgery. TEG 5000 and TEG 6s showed slightly different result patterns for several parameters, particularly for clot initiation time and fibrinogen activity.
CONCLUSION
TEG was more informative than conventional tests, showing peak coagulation derangements during anhepatic and post-reperfusion phases of liver transplantation, likely driven by platelet dysfunction and warranting increased vigilance for coagulopathy.
Core Tip: This study describes intraoperative coagulation abnormalities across different phases of liver transplantation using thromboelastography. Findings highlight that coagulopathy peaks during the anhepatic and post-reperfusion phases, primarily driven by platelet dysfunction, underscoring the importance of targeted transfusion and antifibrinolytic strategies to optimize hemostatic management during these critical stages.
