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Timing of Factor VII a in Liver Transplantation Impacts Cost and Clinical Outcomes
Author(s) -
Scheffert Jenna L.,
Taber David J.,
Pilch Nicole A.,
McGillicuddy John W.,
Baliga Prabhakar K.,
Chavin Kenneth D.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1230
Subject(s) - medicine , perioperative , intensive care unit , propensity score matching , liver transplantation , blood product , surgery , retrospective cohort study , transplantation , single center , anesthesia
Study Objective To investigate the clinical and economic outcomes associated with the use of recombinant factor VIIa ( rFVII a) in perioperative liver transplantation (LT). Design Retrospective review. Setting Academic medical center. Patients A total of 63 adults who underwent LT between January 2000 and September 2008 and received rFVII a prior to or during the procedure. Using a propensity‐scoring method, these patients were matched in a 1:2 ratio with 120 controls. Measurements and Main Results Of the 473 patients who received any LT during the study period, 63 (13%) received rFVII a and were matched with propensity score matched controls at a ratio of approximately 1:2. Of those who received rFVII a, 27 (43%) received preemptive administration and 14 (22%) received intraoperative administration. (The remaining 22 patients received rFVIIa outside of a 12‐hour window of time before or after surgery.) Clinical outcomes were similar between the preemptive and the control groups, although patients in the control group had a shorter length of stay in the intensive care unit (ICU) and incurred fewer expenses. Compared with both the preemptive and the control groups, patients who received rFVII a intraoperatively required more blood products, longer stays in the ICU, and incurred higher costs. They also had poorer graft survival and decreased overall survival rates at 30 days and 1 year. Conclusion Intraoperative administration of rFVII a in LT was associated with higher blood product use, lower graft and patient survival rates, longer ICU stays, and higher overall costs compared with preemptive administration. The use of preemptive rFVII a in select high‐risk LT patients may prevent the development of poor clinical outcomes and may be more cost effective compared with intraoperative administration.