Phase-specific dynamics of coagulation factors V, VIII, and XIII during liver transplantation: insights from a prospective study.

Abstract

Liver dysfunction is associated with a rebalanced but fragile hemostatic system, in which alterations in coagulation factor synthesis and activity contribute to both bleeding and thrombotic risks. During liver transplantation, this fragile equilibrium is further challenged by major physiological stress. This study aimed to characterize the phase-specific intraoperative dynamics of coagulation factors V, VIII, and XIII (FV, FVIII, and FXIII) to better understand hemostatic modulation and its clinical implications during liver transplantation. A subset of 17 liver transplant recipients receiving transfusion support without administration of recombinant FVIII or FXIII was analyzed. Measurements were obtained at three defined intraoperative time points: T1 anesthesia induction, T2 end of anhepatic phase, T3 end of surgery. Activities of FV, FVIII, and FXIII were quantified and analyzed for temporal trends. All three coagulation factors declined during surgery. FV was already markedly reduced at T1 (37% (22/55)) and further decreased to 26% at T3 ((19/34); p = 0.0309). FVIII showed supranormal levels at T1 (193% (160/254) and declined to near-normal levels at T3 (109% ((67/143); p < 0.0001). FXIII remained close to the lower limit of normal (T1: 68% (50/85)); T3: (63% (55/78)) without significant change. This prospective analysis reveals distinct, phase-specific trajectories of FV, FVIII, and FXIII during liver transplantation. Understanding these differential patterns may help identify critical periods of hemostatic vulnerability and guide individualized factor-specific therapeutic interventions to optimize perioperative coagulation management in liver transplant recipients. German Clinical Trials Register (DRKS00032827).