Background: Improvement of surgical and anesthetic techniques, allowed total avoidance of blood transfusion\r\nduring liver transplantation (LT) in some cases. The last years showed much debate about prophylactic administration\r\nof rFVIIa with no guide for its rational use. Giving that it is off label, preoperative ROTEM assessed coagulation\r\nreserve may help its judicious use.\r\nPatients and methods: 3 groups retrospectively studied; (NRNB) n=38 not given rFVIIa and no blood\r\ntransfusion (BT), (RNB) n=43 given rFVIIa and no BT and (RAB) n=35 given rFVIIa and BT. 40 ug/kg rFVIIa were\r\ngiven. Comparison NRNB vs. RNB group answers need or not need rFVIIa to achieve bloodless surgery (decision\r\nof admission), while RNB vs. RAB group determine which patients rFVIIa can help to achieve bloodless surgery\r\n( responders and non responders). Data collected: Preoperative Extem, Fibtem, hemoglobin (HB), INR, platelet,\r\nfibrinogen, blood loss, and blood transfused in RAB group.\r\nResults: NRNB group had significantly higher HB, fibrinogen, platelets, and better ROTEM values vs. RNB.\r\nRAB had significantly lower HB, fibrinogen, platelets, and worse ROTEM values vs. RNB. Preoperative HB,\r\nfibrinogen level and ROTEM values are highly significant predictors to rFVIIa response. In RAB group, PRBCs\r\ntransfusion correlated with preoperative HB and Ex MCF, platelet transfusion correlated with Ex MCF, angle a and\r\nCFT, cryoprecipitate transfusion correlated with fibrinogen and Fibtem MCF, plasma transfusion correlated with\r\nExCT and ExCFT. Preoperative Rotem and HB cut values are sensitive and specific for admission and response to\r\nrFVIIa to achieve bloodless surgery.\r\nConclusion: ROTEM may help rational rFVIIa use, considering safety and cost, to achieve bloodless surgery.\r\nNon responders (RAB) may still require rFVIIa on risk benefit bases. Correction of HB and higher rFVIIa doses may\r\nimprove their response.
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