Antifibrinolytics in liver transplantation

Abstract

A 27-year-old male with a history of liver transplantation as a child for biliary atresia presents for retransplantation secondary to graft failure due to chronic rejection. Upon presentation to the operating room, his Model for End-Stage Liver Disease (MELD) score is 36. He is oliguric and has just begun single-pass dialysis. He is not intubated and not on any vasopressor infusions. His platelet count is 45,000, his international normalized ratio (INR) is 2.1, and his fibrinogen levels are 95 mg/dL. Since this is a redo liver transplantation, you place 2 large bore central venous catheters in anticipation of massive bleeding and transfusion requirements. The surgeon asks you if it would be appropriate to administer tranexamic acid prophylactically in order to minimize bleeding risk.