Characteristics and Outcomes of Liver Transplantation Recipients after Tranexamic Acid Treatment and Platelet Transfusion: A Retrospective Single-Centre Experience.

Background and Objectives: Patients undergoing liver transplantation (LT) often require increased blood product transfusion due to pre-existing coagulopathy and intraoperative fibrinolysis. Strategies to minimise intraoperative bleeding and subsequent blood product requirements include platelet transfusion and tranexamic acid (TXA). Prophylactic TXA administration has been shown to reduce bleeding and blood product requirements intraoperatively. However, its clinical use is still debated. The aim of this study was to report on a single-centre practice and analyse clinical characteristics and outcomes of LT recipients according to intraoperative treatment of TXA or platelet transfusion. Materials and Methods: This was a retrospective observational cohort study in which we reviewed 162 patients' records. Characteristics, intraoperative requirement of blood products, postoperative development of thrombosis and outcomes were compared between patients without or with intraoperative TXA treatment and without or with platelet transfusion. Results: Intraoperative treatment of TXA and platelets was 53% and 57.40%, respectively. Patients who required intraoperative administration of TXA or platelet transfusion also required more transfusion of blood products. Neither TXA nor platelet transfusion were associated with increased postoperative development of hepatic artery and portal vein thrombosis, 90-day mortality or graft loss. There was a significant increase in the median length of intensive care unit (ICU) stay in those who received platelet transfusion only (2.00 vs. 3.00 days; p = 0.021). Time to extubate was significantly different in both those who required TXA and platelet transfusion intraoperatively. Conclusions: Our analysis indicates that LT recipients still required copious intraoperative transfusion of blood products, despite the use of intraoperative TXA and platelets. Our findings have important implications for current transfusion practice in LT recipients and may guide clinicians to act upon these findings, which will support global efforts to encourage a wider use of TXA to reduce transfusion requirements, including platelets.

Consensus guidelines of cardiovascular risk assessment in kidney transplantation in Saudi Arabia: Review of current practice, evidence, and recommendations.

Screening for cardiovascular (CV) disease before transplant is common. However, the clinical utility of screening asymptomatic transplant candidates remains unclear. There is a large degree of variation among the practices of the different transplant centers in the Kingdom of Saudi Arabia (KSA) and among the international guidelines. Opinions are mostly based on mixed observational data with a great potential for bias. When compared to the Western countries, renal-transplant candidates in the KSA are likely to have longer dialysis vintage, higher prevalence of catheter use, higher rate of uncontrolled hyperparathyroidism, and high prevalence of diabetes. These factors are likely to expose renal-transplant candidates to a higher CV risk than those in Western countries. In the absence of any published guideline for CV risk assessment of the renal-transplant candidate in the KSA, we present these guidelines as the first published guidelines in the KSA. These guidelines review the pertinent aspects from the most recent American College of Cardiology/American Heart Association guidelines for cardiac disease evaluation and management among kidney-transplant candidates and reflect on the local practices in the KSA. These guidelines overview many of the daily- encountered challenges in renal transplantation such as the indications for stress testing, screening coronary angiogram and prophylactic revascularization, screening and management of pulmonary hypertension, cardiac surveillance while on the waiting list and duration of dual-antiplatelet therapy before renal transplant. These guidelines were reviewed by a team of consultant nephrologists, cardiologists, anesthesiologists, and transplant surgeons from six major transplant centers in the KSA. The guidelines aim to standardize the practices of CV risk assessment in kidney transplantation in the KSA, according to the most up-to-date available evidence. The expected impact of these guidelines on the current practices is also reviewed here.