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Division of Anaesthesiology, Department of Anaesthesia, Singapore General Hospital, Singapore Background: Orthotopic liver transplantation surgery is associated with major bleeding, often requiring transfusions of blood products such as red cell concentrates, plasma, platelets and cryoprecipitate. Fibrinogen concentrate was made available in our institution in January 2017 and is increasingly being used as an alternative strategy to reduce transfusion requirements. Limited literature exists to show the effectiveness of fibrinogen concentrate on blood loss during liver transplantation surgery, as well as its impact on blood transfusion requirements. Methods: This is a retrospective, observational study conducted at a single, large, tertiary centre in Singapore to evaluate the impact of incorporating fibrinogen concentrate on blood transfusion requirements during orthotopic liver transplantation surgery from January 2014 to December 2018. Results: A total of 54 patients who underwent liver transplantation during this period were studied. Forty patients did not receive fibrinogen concentrate during the surgery while 14 patients did. No statistically significant difference was detected in the baseline preoperative characteristics of both groups of patients in terms of MELD or preoperative INR. The mean INR in patients who did not receive fibrinogen concentrate was 1.77 while that in patients who received fibrinogen concentrate was 2.21. While not statistically significant, clinically this may be of significance. There was a significant difference in the starting haemoglobin level of the patients, with a lower starting haemoglobin level in patients who received fibrinogen concentrate (p=0.039). No significant difference was noted in the amount of blood loss, amount of red cell transfusions and amount of fresh plasma transfused. Of note, patients who received fibrinogen concentrate had a significantly less amount of cryoprecipitate transfused compared to those who did not (p=0.002). Conclusion: The intraoperative use of fibrinogen concentrate did not seem to have any statistically significant difference in the amount of blood loss during surgery. However, the amount of cryoprecipitate used was significantly reduced with the introduction of fibrinogen concentrate.

international journal of clinical transfusion medicine

&lt;p&gt;Impact of Incorporation of Fibrinogen Concentrate in Blood Transfusion Management During Liver Transplantation: An Early Local (Single Centre) Experience&lt;/p&gt;