Management of Coagulopathy During Orthotopic Liver Transplantation. Comparison Between ROTEM-based Management and Standard Biological Assessment.

"Transfusional protocol for Standard group Red Blood cells concentrate if Hemoglobin \<9 gram per liter Fibrinogen 3 gram, if fibrinogen \<1gram per liter~Platelet concentrate :~* if platelets \<50gram per liter before transfusion, at anhepatic phase, or in case of bleeding.~* if platelets \<30gram per liter at vascular unclamping time at the end of intervention or without bleeding 2 Fresh frozen plasma if :~* if prothrombin\<40% before transfusion at anhepatic phase or in case of bleeding.~* if prothrombin\<30% at vascular unclamping time at the end of intervention or without bleeding Bolus Tranexamic acid 1g and 3g every 24 hours in case of fibrin degradation products.~Analyses common to both groups: NFS, chemistry panel with ionized serum calcium, blood gas with lactates, HemoCue ®, capillary blood glucose.~Analyses in S Group only: coagulation profile (PT, APTT, INR, fibrinogen, platelet count, soluble complexes, PDF)."

"Transfusional protocol for Rotem group. Red Blood cells concentrate if Hemoglobin \<9 gram per liter Fibrinogen 3 gram, if A10 FIBTEM \<8 mm~Platelet concentrate :~* If MCF EXTEM \<40mm or A10\<35 mm and MCF or A10 FIBTEM \>8mm.~* If platelets \<30gram per liter at vascular unclamping time at the end of intervention or without bleeding.~ 2 Fresh frozen plasma if CT EXTEM \>100s.~Bolus Tranexamic acid 1g and 3g every 24 hours :~* if fibrinolysis in EXTEM~* Reduction of 15 % of clotting time or clot formation time and increase of maximum clot firmness in APTEM compared to EXTEM, or maximal lysis at 60 minutes \>15%.~Analyses in R group only: blood sampling on citrated tube for ROTEM analysis (EXTEM, INTEM, FIBTEM, APTEM +/- HEPTEM), coagulation profile (same as that of the S Group, for emergency procedure).~Analyses common to both groups: NFS, chemistry panel with ionized serum calcium, blood gas with lactates, HemoCue ®, capillary blood glucose."