Optimizing platelet transfusion thresholds based on TEG maximum clot strength (MA value) to reduce platelet usage and improve patient outcomes in liver transplantation: a cohort study

Background Liver transplantation (LT) is a highly complex procedure often requiring substantial blood product transfusions. Conventional platelet transfusion practices rely on static platelet count thresholds, potentially leading to overuse and associated risks. Thromboelastography (TEG) offers dynamic assessment of clotting, particularly through the Maximum Clot Strength (MA) value, which may optimize platelet transfusion thresholds and improve outcomes. Methods This retrospective cohort study analyzed 231 patients who underwent LT between January 2019 and December 2023. Patients were divided into the TEG group ( n = 103) receiving platelet transfusions guided by TEG MA values < 55 mm, and the conventional platelet count transfusion (CPCT) group ( n = 128) with transfusions based on platelet counts < 50 × 10 9 /L. TEG was performed using kaolin-activated citrated whole blood samples. Propensity score matching was employed to control for potential confounders. Both groups were compared for platelet usage, postoperative outcomes, and quality of life (QOL) assessed via the SF-36 survey at 1 month post-surgery. Results After propensity matching, the TEG group demonstrated significant reductions in platelet transfusions on postoperative days 1 and 3 compared to the CPCT group (36.9 vs. 61.7% on day 1, P < 0.001; 5.8 vs. 19.5% on day 3, P = 0.002). No significant differences were observed in red blood cell or plasma transfusions. The TEG group experienced enhanced postoperative QOL, with higher scores in Physical Functioning, Role-Physical, General Health, Vitality, Social Functioning, and Role-Emotional ( P < 0.05 for each domain). No significant differences were observed in mortality or major complications between groups. Conclusion Implementing TEG-guided platelet transfusion strategies in LT significantly reduces platelet use and improves patient QOL by providing real-time functional hemostasis assessments.