Thromboelastographic description of intraoperative coagulopathy in patients undergoing liver transplant surgery: A single-center observational study

doi:10.5500/wjt.v16.i2.118880

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 118880
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118880

Table 1 Demographic, clinical characteristics and postoperative variables of patients undergoing liver transplant surgery, mean ± SD/n (%)

Characteristic	Result (n = 364)
Age at OLT, years	56.7 ± 10.6
Sex
Female	123 (33.8)
Male	241 (66.2)
Race
Asian	5 (1.4)
Black	24 (6.6)
White	271 (74.5)
Other	64 (17.5)
Body mass index, kg/m²	29.1 ± 5.9
MELD-Na score pre-surgery	22.2 ± 8.7
Blood type
A	147 (40.4)
AB	22 (6.0)
B	49 (13.5)
O	144 (39.6)
Unknown	2 (0.5)
Comorbidities
Chronic pulmonary disease	32 (8.8)
Diabetes	102 (28.0)
End-stage renal disease	10 (2.7)
Hypertension	171(47.0)
Cause of liver failure
Autoimmune hepatitis	16 (4.4)
Alcohol-related	166 (46.6)
Cholangiocarcinoma	5 (1.4)
Cryptogenic	14 (3.8)
Hepatocellular carcinoma	81 (22.3)
Hepatitis C	59 (16.2)
Hepatitis B	8 (2.2)
MASH	87 (23.9)
Primary sclerosing cholangitis	33 (9.1)
Primary biliary cholangitis	17 (4.7)
Other	12 (3.3)
TEG platform
TEG 5000	246 (67.6)
TEG 6s	118 (32.4)
Type of transplant
Deceased donor liver transplant	329 (90.4)
Living donor liver transplant	35 (9.6)
Donor type
Donation after brain death	253 (69.5)
Donation after circulatory death	76 (20.9)
Living donor	35 (9.6)
Tranexamic acid used
Pre-anhepatic	62 (17.0)
Anhepatic	11 (3.0)
Post-reperfusion	108 (29.7)
Quantity of intraoperative blood product units
Packed red blood cells	4.4 ± 6.4
Cell saver units	4.0 ± 4.7
Fresh frozen plasma	5.8 ± 6.7
Cryoprecipitate	1.6 ± 1.9
Platelets	1.0 ± 1.3
Intraoperative CVVH	23 (6.3)
ICU length of stay, days	4.8 ± 15.6
Intubated upon ICU admission	143 (39.3)
Mechanical ventilation duration, hours	22.1 ± 23.2
ICU transfusion within 72 hours
Packed red blood cells	147 (40.3)
Fresh frozen plasma	135 (37.08)
Cryoprecipitate	116 (31.8)
Platelets	83 (22.8)
Need for re-operation within 7 days	37 (10.2)
Mortality at 30 days	3 (0.8)

OLT: Orthotopic liver transplantation; MELD-Na: Model end-stage liver disease sodium; MASH: Metabolic dysfunction–associated steatohepatitis; TEG: Thromboelastography; CVVH: Continuous veno-venous hemofiltration; ICU: Intensive care unit.

Full Size Table

Table 2 Distribution of coagulation measures by thromboelastography across 4 phases of liver transplant surgery, n (%)

TEG parameters and levels	Distribution of TEG levels across liver transplant surgical phases
TEG parameters and levels	Pre-anhepatic	Anhepatic	Post-reperfusion	End of surgery
Clot initiation time
CK R (TEG 6s)	n = 116	n = 100	n = 116	n = 113
Shortened/Low	19 (16.4)	22 (22.0)	22 (19.0)	12 (10.6)
Normal	87 (75.0)	46 (46.0)	54 (55.2)	85 (75.2)
Prolonged/high	10 (8.6)	32 (32.0)	30 (25.9)	16 (14.2)
R (TEG 5000)	n = 214	n = 175	n = 206	n = 207
Shortened/Low	148 (69.2)	150 (85.7)	93 (45.1)	116 (56.0)
Normal	64 (29.9)	23 (13.1)	94 (45.6)	84 (40.6)
Prolonged/high	2 (0.9)	2 (1.1)	19 (9.2)	7 (3.4)
Clot formation
CFF MA (TEG 6s)	n = 112	n = 94	n = 116	n = 113
Shortened/Low	40 (35.7)	49 (52.1)	53 (45.7)	55 (48.7)
Normal	62 (55.4)	38 (40.4)	60 (51.7)	57 (50.4)
Prolonged/high	10 (8.9)	7 (7.4)	3 (2.6)	1 (0.9)
CFF FLEV (TEG 6s)	n = 46	n = 46	n = 76	n = 62
Shortened/Low	18 (39.1)	25 (54.3)	39 (51.3)	36 (58.1)
Normal	26 (56.5)	20 (43.5)	35 (46.1)	26 (41.9)
Prolonged/high	2 (4.3)	1 (2.2)	2 (2.6)	ND
K (TEG 5000)	n = 212	n = 175	n = 199	n = 203
Shortened/Low	147 (69.3)	123 (70.3)	80 (40.2)	105 (51.7)
Normal	60 (28.3)	44 (25.1)	80 (40.2)	84 (41.4)
Prolonged/high	5 (2.4)	8 (4.6)	39 (19.6)	14 (6.9)
α-angle (TEG 5000)	n = 214	n = 175	n = 205	n = 205
Shortened/Low	4 (1.9)	5 (2.9)	35 (17.1)	10 (4.9)
Normal	37 (17.3)	28 (16.0)	48 (23.4)	43 (21.0)
Prolonged/high	173 (80.8)	142 (81.1)	122 (59.5)	152 (74.1)
Fibrinolysis
CK LY30 (TEG 6s)	n = 78	n = 58	n = 78	n = 74
Normal	69 (88.5)	43 (74.1)	67 (85.9)	73 (98.6)
Prolonged/high	9 (11.5)	15 (25.9)	11 (14.1)	1 (1.4)
LY30 (TEG 5000)	n = 213	n = 175	n = 204	n = 204
Normal	176 (82.6)	118 (67.4)	161 (78.9)	185 (90.7)
Prolonged/high	37 (17.4)	57 (32.6)	43 (21.1)	19 (9.3)
Platelet contribution to clot strength
CRT MA (TEG 6s)	n = 113	n = 93	n = 114	n = 104
Shortened/Low	61 (54.0)	60 (64.5)	80 (70.2)	73 (70.2)
Normal	51 (45.1)	33 (35.5)	34 (29.8)	31 (29.8)
Prolonged/high	1 (0.9)	ND	ND	ND
MA (TEG 5000)	n = 213	n = 175	n = 204	n = 204
Shortened/Low	92 (43.2)	65 (37.1)	138 (67.6)	109 (53.4)
Normal	106 (49.8)	96 (54.9)	64 (31.4)	92 (45.1)
Prolonged/high	15 (7.0)	14 (8.0)	2 (1.0)	3 (1.5)

TEG: Thromboelastography; CK: Citrated kaolin; R: Reaction time; CFF: Citrated functional fibrinogen; MA: Maximum amplitude; FLEV: Functional fibrinogen level; K: Kinetics time; LY30: Percent clot lysis at 30 minutes post-maximum amplitude; CRT: Citrated rapid thromboelastography; ND: No data.

Full Size Table

Table 3 Distribution of conventional coagulopathy test results over 4 phases of liver transplant surgery in patients concomitantly monitored with thromboelastography, n (%)

Conventional test and level	Distribution of intraoperative conventional coagulopathy test results
	Patients monitored by TEG 5000				Patients monitored by TEG 6s
	Pre-anhepatic	Anhepatic	Post-reperfusion	End of surgery	Pre-anhepatic	Anhepatic	Post-reperfusion	End of surgery
International normalized ratio	n = 156	n = 194	n = 234	n = 234	n = 50	n = 70	n = 98	n = 93
Low/shortened	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Normal	2 (1.3)	1 (0.5)	ND	ND	2 (4.0)	4 (5.7)	ND	ND
High/prolonged	154 (98.7)	193 (99.5)	234 (100)	234 (100)	48 (96.0)	66 (94.3)	98 (100)	93 (100)
Fibrinogen	n = 142	n = 185	n = 222	n = 221	n = 50	n = 62	n = 93	n = 89
Low	74 (52.1)	111 (60.0)	166 (74.8)	149 (67.4)	25 (50.0)	43 (69.4)	76 (81.7)	58 (65.2)
Normal	63 (44.4)	71 (38.4)	53 (23.9)	69 (31.2)	23 (46.0)	19 (30.6)	17 (18.3)	31 (34.8)
High	5 (3.5)	3 (1.6)	3 (1.4)	3 (1.4)	2 (4.0)	ND	ND	ND
Partial thromboplastin time	n = 155	n = 194	n = 234	n = 234	n = 51	n = 70	n = 99	n = 93
Shortened	ND	ND	ND	ND	1 (2.0)	ND	ND	1 (1.1)
Normal	55 (35.5)	59 (30.4)	12 (5.1)	19 (8.1)	7 (13.7)	12 (17.1)	6 (6.1)	11 (11.8)
Prolonged	100 (64.5)	135 (69.6)	222 (94.9)	215 (91.9)	43 (84.3)	58 (82.9)	93 (93.9)	81 (87.1)
Platelets	n = 155	n = 192	n = 231	n = 231	n = 58	n = 65	n = 96	n = 94
Low	136 (87.7)	170 (88.5)	213 (92.2)	214 (92.6)	52 (89.7)	58 (89.2)	87 (90.6)	88 (93.6)
Normal	18 (11.6)	22 (11.5)	18 (7.8)	16 (6.9)	6 (10.3)	7 (10.8)	9 (9.4)	6 (6.4)
High	1 (0.6)	ND	ND	1 (0.4)	ND	ND	ND	ND

TEG: Thromboelastography; N/A: Not applicable; ND: No data.

Full Size Table

Citation: 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
URL: https://www.wjgnet.com/2220-3230/full/v16/i2/118880.htm
DOI: https://dx.doi.org/10.5500/wjt.v16.i2.118880

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]

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