Tohoku J. Exp. Med., 2025 February, 265(2)

Practical Coagulation Management in Liver Transplantation Through Point-of-Care Analysis Using the TEG 6s Global Hemostasis System in Japan

Muneyuki Matsumura,¹ Kengo Sasaki,¹ Kazuaki Tokodai,¹ Koji Miyazawa,¹ Atsushi Fujio,¹ Hiroyuki Ogasawara,¹ Michiaki Unno¹ and Takashi Kamei¹

¹Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

Liver transplantation (LT) is the standard treatment for end-stage liver disease. However, owing to a precarious balance between pro- and anticoagulation factors, patients undergoing LT are at high risk of massive bleeding and vascular thromboembolic complications. Thromboelastography (TEG) allows for the rapid, comprehensive, and accurate identification of coagulation monitoring undergoing LT. Newly released TEG 6s global hemostasis systems have been introduced, which we hypothesized could contribute to practical coagulation management in LT. TEG 6s was used for 15 patients undergoing LT at eight preset times during and after LT. Anesthesiologists and a surgical intensive care team managed coagulation during and after LT, based fully on TEG 6s findings. We focused on the citrated kaolin reaction time, citrated kaolin maximum amplitude, and functional fibrinogen maximum amplitude. TEG 6s was also used to determine transfusion principles with a focus on the details of cases with difficult to manage coagulation. Among 15 LT patients, six had massive bleeding-related complications and vascular thromboembolic complications. Case management and detailed TEG 6s results were reviewed. We recommend using the TEG 6s to obtain a comprehensive understanding of coagulation management as this global hemostasis system offers superior insights compared with standard laboratory tests.

Key words —— coagulation management; liver transplantation; thromboelastogram; thromboelastography 6s

© 2025 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2025 February, 265(2), 59-67.

Correspondence: Muneyuki Matsumura, M.D., Ph.D., Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-0872, Japan.

e-mail:muneyuki.matsumura.a6@tohoku.ac.jp