Our Summary

This paper discusses a blood test called Thromboelastography (TEG). This test is very useful because it quickly shows how well your blood can form a clot, which can be critical information for doctors during surgeries or for patients needing a liver transplant. Traditional blood clot tests have some limitations: they take longer to get results and don’t give a full picture of how well and how strong the blood can clot. Moreover, these older tests often don’t match up with actual bleeding events and can sometimes lead to unnecessary blood transfusions.

People with severe liver failure often have a messed up clotting system because their liver can’t properly produce the things needed for clotting. Using TEG to decide when and how much to transfuse in these patients - particularly those waiting for, undergoing, or recovering from a liver transplant - is still not strongly supported by lots of research. However, the studies that do exist suggest that using TEG leads to fewer blood transfusions without increasing the risk of death or complications.

The authors of the paper suggest that more high-quality studies should be done to better understand how TEG can be used to guide transfusion decisions, especially after a liver transplant.

FAQs

  1. What is Thromboelastography (TEG) and why is it useful?
  2. How does TEG compare to traditional blood clot tests in terms of efficiency and accuracy?
  3. Why is there a need for more high-quality studies on the use of TEG in transfusion decisions, particularly for liver transplant patients?

Doctor’s Tip

In addition to following your doctor’s recommendations for post-transplant care, it is important to maintain a healthy lifestyle by eating a balanced diet, exercising regularly, avoiding alcohol and tobacco, and taking any prescribed medications as directed. It is also important to attend all follow-up appointments and communicate any concerns or changes in your health to your medical team. By taking these steps, you can help ensure the success of your liver transplant and improve your overall health and well-being.

Suitable For

Patients who are typically recommended for a liver transplant include those with end-stage liver disease, cirrhosis, liver cancer, and acute liver failure. These patients may experience complications such as excessive bleeding during surgery due to their liver’s inability to properly produce clotting factors. Therefore, utilizing TEG to monitor and guide transfusion decisions in these patients could be beneficial in improving outcomes and reducing the need for unnecessary blood transfusions. More research is needed to further validate the use of TEG in this population.

Timeline

  • Before liver transplant:
  1. Patient is diagnosed with severe liver failure and is evaluated by a transplant team.
  2. Patient undergoes a series of tests and evaluations to determine if they are a suitable candidate for a liver transplant.
  3. Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available.
  4. Patient may experience worsening symptoms of liver failure and complications such as jaundice, ascites, and hepatic encephalopathy.
  • During liver transplant:
  1. Patient receives a donor liver through a surgical procedure.
  2. The transplant team monitors the patient closely during and after the surgery for any complications.
  3. The new liver begins to function and the patient’s liver function gradually improves.
  • After liver transplant:
  1. Patient is closely monitored in the hospital for signs of organ rejection or complications.
  2. Patient may need to take immunosuppressant medications to prevent rejection of the transplant.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and function.
  4. Patient may experience side effects of medications, such as increased risk of infection, diabetes, and kidney problems.
  5. Over time, the patient’s liver function stabilizes and they are able to resume normal activities.
  6. Patient continues to follow up with their transplant team for regular check-ups and monitoring of liver function.

What to Ask Your Doctor

  1. Can TEG be used to help guide transfusion decisions before, during, and after a liver transplant?
  2. How does TEG compare to traditional blood clot tests in terms of speed and accuracy?
  3. Are there any risks or potential complications associated with using TEG during a liver transplant?
  4. What specific information can TEG provide that other blood clot tests cannot?
  5. How will the results of TEG be used to determine the need for blood transfusions during and after a liver transplant?
  6. Are there any specific factors or conditions that may affect the accuracy of TEG results in patients with liver failure?
  7. Are there any ongoing research studies or clinical trials investigating the use of TEG in liver transplant patients?
  8. How often will TEG be performed before, during, and after the liver transplant surgery?
  9. How will the results of TEG be communicated to other healthcare providers involved in the patient’s care?
  10. Will TEG results be used to adjust the patient’s treatment plan or medication regimen as needed?

Reference

Authors: Hawkins RB, Raymond SL, Hartjes T, Efron PA, Larson SD, Andreoni KA, Thomas EM. Journal: Transplant Proc. 2018 Dec;50(10):3552-3558. doi: 10.1016/j.transproceed.2018.07.032. Epub 2018 Aug 9. PMID: 30577236