Use of decision algorithms for viscoelastic tests and use of blood products in patients undergoing liver transplantation: A systematic review with meta-analysis

Introduction: Viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of hemostatic function. The use of a TEG or ROTEM system to guide the administration of blood products has been shown to reduce transfusion requirements in certain types of surgeries, but the decision algorithms for Viscoelastic tests needs to be assessed. This review aimed to assess all published evidence on viscoelastic testing in the context the use of decision algorithms for VETs on liver transplantation. Methods: A systematic review was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies assessing VETs for liver transplantation were considered for inclusion, analyzed according to the use or non-use of algorithms for VETs. Results: Out of the 279 studies initially identified, 17 studies were included in this review. Algorithms for VETs reduced red blood cell transfusion (−0.44 (95 % CI -0.62; −0.25; p < 0.01), while there was no significant difference with VETs without algorithms, and the overall measure showed a smaller reduction (−0.33; 95 % CI -0.61 to −0.04; p = 0.02). Conclusion: The results highlight the potential of algorithms for VETs to reduce the use of blood products in liver transplants.