Thromboelastography and liver transplantation.

TEG has played an integral part in the growth of liver transplantation. The group at the University of Pittsburgh early on realized that coagulation dysfunction during liver transplantation would be both severe and dynamic. Each phase of the operation appears to have both predictable and unexpected changes in clot dynamics. The routine coagulation profile, although of great use, does not provide an overview of the interaction of stimulators, inhibitors, and available procoagulants to effect a final process, the production of a solid clot. The TEG is a unique gross test of clot strength perfectly suited to the changes during liver transplantation. The initial pioneering work during liver transplantation has inspired the work of others in related surgical fields to explore its utility. There is little doubt that its full utility has not yet been realized. Many questions still remain with regard to liver transplantation. New medications such as aprotinin will be applied to this procedure over the next few years. What effect these new medications will have on hemorrhage or thrombosis of vascular anastomoses is yet to be adequately explored. A new awareness appears to be arriving that normal or excessively hypercoagulable states could contribute to such thromboses. TEG as a technology will certainly contribute to a number of future studies and clinical care, which will enhance the conduct of liver transplantation in the future.