Ohio State University, Columbus, Ohio, USA.
University of Virginia, Charlottesville, Virginia, USA.
Liver Transpl. 2023 Nov 1;29(11):1216-1225. doi: 10.1097/LVT.0000000000000138. Epub 2023 Mar 29.
Blood loss and transfusion of blood products are key concerns during liver transplantation. Whole-blood viscoelastic testing devices have been used to monitor hemostatic function and guide the transfusion of blood products in this patient population. The Quantra System with the QStat Cartridge is a new point-of-care, closed-system viscoelastic testing device that measures changes in clot stiffness during coagulation and fibrinolysis using ultrasound detection of resonance. The aim of this multicenter prospective observational study was to evaluate the Quantra System against the ROTEM delta device in monitoring coagulation and fibrinolysis in patients undergoing liver transplantation. One hundred twenty-five (125) adult subjects (above 18 y old) were enrolled across 5 medical centers in the US. Blood samples were collected at a minimum of 3-time points: preincision (baseline), during the anhepatic phase, and after the start of reperfusion. Performance was assessed as the correlation of equivalent measurements from the QStat Cartridge and ROTEM delta INTEM, EXTEM, and FIBTEM assays. In addition, a clinical concordance analysis was performed to assess the agreement between the 2 devices related to the detection of fibrinolysis. The correlation between the 2 viscoelastic testing devices was strong, with r -values ranging between 0.88 and 0.95, and the overall agreement with respect to detecting fibrinolysis was 90.3% (CI, 86.9%-93.2%). The results indicate that the Quantra with the QStat Cartridge provides comparable information as the ROTEM delta in the assessment of hemostatic function during a liver transplant. Quantra's simplicity of use and availability of rapid results may provide clinicians with a faster, more convenient means to assess coagulation and fibrinolysis status in the operating room and critical care setting.
血液丢失和血制品输注是肝移植过程中的关键关注点。全血黏弹性检测设备已被用于监测止血功能并指导该患者人群的血制品输注。Quantra 系统与 QStat 试剂盒是一种新的即时、封闭系统黏弹性检测设备，它使用超声检测共振来测量凝血和纤溶过程中血凝块硬度的变化。这项多中心前瞻性观察性研究的目的是评估 Quantra 系统在监测肝移植患者凝血和纤溶方面与 ROTEM delta 设备的对比。在美国的 5 家医疗中心共纳入了 125 名（年龄大于 18 岁）成年受试者。在至少 3 个时间点采集血样：切皮前（基线）、无肝期和再灌注开始后。性能评估是通过 QStat 试剂盒和 ROTEM delta INTEM、EXTEM 和 FIBTEM 检测的等效测量值的相关性来进行的。此外，还进行了临床一致性分析，以评估 2 种设备在检测纤溶方面的一致性。这两种黏弹性检测设备的相关性很强，r 值范围在 0.88 到 0.95 之间，在检测纤溶方面的总体一致性为 90.3%（CI，86.9%-93.2%）。结果表明，在评估肝移植期间止血功能方面，使用 QStat 试剂盒的 Quantra 与 ROTEM delta 提供了可比较的信息。Quantra 的使用简便性和快速获得结果的可用性可能为临床医生在手术室和重症监护环境中评估凝血和纤溶状态提供了更快、更方便的手段。
