Abstract
BACKGROUND: Bleeding and thrombosis are major perioperative complications in liver transplantation (LT), with mortality rates up to 30%. Bleeding occurs in 0-10% of cases and is 2-3 times more frequent in children than in adults. This study aims to determine the diagnostic significance of specific laboratory tests in predicting adverse outcomes due to thrombohemorrhagic complications in LT. METHODS: This prospective observational analytical study employed a case-control design involving 30 liver recipients. Patients were categorized into two groups based on outcomes: favorable or unfavorable (thrombosis/bleeding leading to fatal outcomes in the early postoperative period). RESULTS: Among 30 patients, 17 (56.7%) had favorable outcomes without complications, while 13 (43.3%) experienced complications early postoperatively. Specifically, portal vein thrombosis (PVT) occurred in 7 (23.3%) cases, and fatal outcomes in the early postoperative period were observed in 5 (16.7%) cases. However, complications were successfully managed in 8 patients. Receiver operating characteristic (ROC) analysis demonstrated prognostic significance in predicting fatal thrombohemorrhagic complications post-LT for the following parameters: fibrinogen level below 160.1 mg/dL within the first day post-surgery showed a sensitivity of 89% and specificity of 96%, with an area under the ROC curve (AUC) of 0.896 (P<0.05), antithrombin-III levels below 15%, protein C levels below 17%, and plasminogen activity below 21% within the first day post-intervention. Intraoperative blood loss exceeding 1,200 mL was identified as a risk factor for hemorrhagic complications post-LT. CONCLUSIONS: Key predictors of fatal thrombohemorrhagic complications following LT include antithrombin-III levels below 15%, protein C levels below 17%, and plasminogen activity below 21% on the first day post-surgery. A fibrinogen level under 160.1 mg/dL on the first day post-surgery, demonstrating 89% sensitivity and 96% specificity, strongly predicts fatal complications. Intraoperative blood loss over 1,200 mL represents a significant risk factor for post-LT hemorrhagic complications.