ORIGINAL RESEARCH article
Front. Med.
Sec. Hepatobiliary Diseases
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
Pingping Qi 1
Chunli Wu 2
Jianyue Zhou 1
Rong Tang 3
1. The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
2. First Affiliated Hospital of Harbin Medical University, Harbin, China
3. Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
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Abstract
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 one 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.
Summary
Keywords
coagulopathy, Liver Transplantation, Maximum Clot Strength, Platelet Transfusion, Postoperative quality of life
Received
17 October 2025
Accepted
05 January 2026
Copyright
© 2026 Qi, Wu, Zhou and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Rong Tang
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