Should abnormal coagulation data found in thromboelastography be corrected during liver transplantation? Experience of two cases

Coagulopathy is common in patients with end-stage liver disease requiring liver transplantation (LT). Thromboelastography (TEG) test results are used for analyzing coagulation data and making a decision about the transfusion requirements. However, whether it is necessary to correct the abnormal coagulation profile during LT is a matter of considerable debate. Herein, we report our experience with two patients who had LT without blood product transfusion despite TEG results showing abnormal coagulation data. The TEG was performed four times during LT. Although blood product transfusion was necessary according to the TEG guidelines, it was avoided. At the end of operation, the hemoglobin level was 8.5 g/dL and 9.5 g/dL for Patient 1 and Patient 2, respectively. The patients tolerated LT well and their subsequent recovery was uneventful. We suggest that TEG should be used cautiously to make a decision about blood transfusion, as it can be totally avoided in selected cases involving living donor LT.