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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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1434-6621
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Volume 57, Issue 6

Issues

Point-of-care haemostasis monitoring during liver transplantation is cost effective

Antonio Leon-Justel / Ana I. Alvarez-Rios
  • Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain
  • Instituto de Biomedicina de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Seville, Spain
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jose A. Noval-Padillo
  • Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain
  • Instituto de Biomedicina de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Seville, Spain
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Miguel A. Gomez-Bravo / Manuel Porras / Laura Gomez-Sosa / Juan L. Lopez-Romero / Juan M. Guerrero
  • Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain
  • Instituto de Biomedicina de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Seville, Spain
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-12-11 | DOI: https://doi.org/10.1515/cclm-2018-0889

Abstract

Background

Optimal haemostasis management in orthotropic liver transplant (OLT) could reduce blood loss and transfusion volume, improve patient outcomes and reduce cost.

Methods

We performed a study including 336 OLTs to evaluate the clinical and cost effectiveness of a new point-of-care (POC)-based haemostatic management approach in OLT patients.

Results

In terms of health benefit we found that the new approach showed a significant reduction in transfusion requirements (red blood cell transfusion units were reduced from 5.3±4.6 to 2.8±2.9 [p<0.001], free frozen plasma from 3.1±3.3 to 0.4±1.0 [p<0.001] and platelets from 2.9±3.9 to 0.4±0.9 [p<0.001], transfusion avoidance, 9.7% vs. 29.1% [p<0.001] and massive transfusion, 14.5% vs. 3.8% [p=0.001]); we also found a significant improvement in patient outcomes, such, reoperation for bleeding or acute-kidney-failure (8.3% vs. 2.4%, p=0.015; 33.6% vs. 5.4%, p<0.001), with a significant reduction in the length of the hospital total stay (40.6±13.8 days vs. 38.2±14.4 days, p=0.001). The lowest cost incurred was observed with the new approach (€73,038.80 vs. €158,912.90) with significant patient saving associated to transfusion avoidance (€1278.36), ICU-stay (€3037.26), total-stay (€3800.76) and reoperation for bleeding (€80,899.64).

Conclusions

POC haemostatic monitoring during OLT is cost effective.

Keywords: blood loss; cost effective; liver transplantation; mobile laboratory; point of care testing

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About the article

Received: 2018-08-16

Accepted: 2018-10-26

Published Online: 2018-12-11

Published in Print: 2019-05-27


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 6, Pages 883–890, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-0889.

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