Analysis of factor concentrates in pediatric patients undergoing living donor liver transplantation: a retrospective, propensity-matched study

Background: Bleeding is a common issue in pediatric living donor liver transplantation (LDLT). Coagulopathy related bleeding can lead to increased morbidity and mortality. There has been limited research on the use of coagulation factor complexes, specifically fibrinogen concentrate (FibC) and prothrombin complex concentrate (PCC), in pediatric LDLT. Methods: Pediatric patients who underwent LDLT between March 2019 and December 2024 were identified. Patients who received FibC and PCC were assigned to the F group(n = 103), while those who did not receive these treatments were designated as the C group (n = 272). After 1:1 propensity score matching, 57 patients were included in each group for analysis. The primary endpoint was the need for red blood cell (RBC) transfusion in pediatric patients undergoing LDLT. Results: There was no significant difference in the volume of RBC infusion between groups F and C (median [interquartile range]: 550.00 (400.00, 600.00) ml vs. 700.00 (400.00, 750.00) ml [p = 0.281]). In terms of plasma and intraoperative bleeding, group F demonstrated a trend toward lower levels compared to group C; however, there was no significant difference between the two groups. The two groups had no significant difference in intraperitoneal drainage volume or RBC infusion volume 24 h after surgery. Both groups also showed no difference in postoperative outcomes such as mechanical ventilation time, ICU stay, and hospital length of stay. Fibrinogen, PT, and INR levels post-surgery were significantly better in Group F than in Group C. Additionally, the groups had no notable differences in postoperative complications, including thromboses or embolism. Conclusions: This study indicates that using FibC and PCC was linked to a trend of reducing intraoperative RBC administration and bleeding in pediatric patients undergoing LDLT, although no significant difference was observed. Coagulopathy management strategies emphasizing targeted factor replacement should be a focus for future research.