The effects of in vitro hemodilution with 6% hydroxyethyl starch (HES) (130/0.4) solution on thrombelastograph analysis in patients undergoing liver transplantation

Introduction: The aim of this study was to determine the effects of in vitro hemodilution with 6% HES (130/0.4) solution on thrombelastograph^® (TEG) parameters in whole blood samples from patients with end-stage liver disease (ESLD). Methods: Enrollment consisted of 95 patients with ESLD undergoing liver transplantation. Blood was diluted by 11%, 22%, and 33% with 6% HES (130/0.4) solution. Normal saline was used as a control diluent. Results: When blood was diluted by 33% with normal saline, only the reaction time (r) was increased (p<0.0001) compared to the baseline value. When blood was diluted with 6% HES (130/0.4), 11% dilution decreased maximum amplitude (MA) (p=0.003) compared to baseline. At 33% dilution, the r (p<0.0001, vs. baseline) and K (p<0.0001, vs. baseline; p<0.0001, vs. normal saline) increased, and the MA, alpha angle, and coagulation index (p<0.0001, vs. baseline; p<0.0001, vs. normal saline) decreased. Conclusion: Hemodilution with 6% HES (130/0.4) solution results in TEG abnormalities even with 11% hemodilution, in whole blood samples of patients with ESLD undergoing liver transplantation.