In our center, a low intraoperative transfusion rate could be maintained throughout 500 consecutive OLTs. Bleeding did not correlate with the severity of recipient's disease. The starting Hb value showed the strongest correlation with OLT without RBC transfusion.

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It was the area of manufacturing in which the idea of continuous quality improvement (CQI) originated and developed to what we consider a highly efficient model for all industries today. [1][2][3][4][5][6] Since the 1980s, when the cost of healthcare began rising faster in the United States than the cost of living, quality issues have gradually gained importance for the medical industry and the government. Furthermore, a systematic assessment of healthcare by the Institute of Medicine in 1999 revealed shocking discrepancies between outcomes. One of the main findings suggested that, despite having one of the best acute care services in the world, the United States fails to deliver consistent quality. A growing body of research has confirmed the existence of wide variations that are attributable to differences in medical practices and are unrelated to patients' preexisting medical conditions. 7 Healthcare leaders recognized long ago that education and continuous systematic development are essential to improving outcome. [8][9][10] To build on the strengths of the current system and address the weakness of inconsistent quality, healthcare organizations have initiated CQI processes with various degrees of success over the last few years. 11Our institution, the University of Wisconsin (UW), is a large transplant center with over 8000 organs transplanted to date, and it is regarded as a pioneer of organ preservation.12 This article describes the decision process, implementation, and results of a newly established dedicated liver transplant anesthesia team since 2003. PATIENTS AND METHODSAfter the commitment was made to develop a state-ofthe-art transplant anesthesiology division at UW, the CQI plan called for a series of educational, organizational, and clinical changes that were to be gradually introduced in a fashion consistent with the plan-dostudy-act cycle. The first step of the new CQI process focused on education. Creating concentrated subspecialty knowledge was accomplished by the creation of a liver transplant anesthesiology case library and the establishment of a new transplant anesthesia rotation for resident training. Evidence-based guidelines [eg, low central venous pressure (CVP) intraoperative fluid management, thromboelastography (TEG), conservative blood transfusion triggers, systematic use of antifibrinolytics for hyperfibrinolysis, and extubation in the operating room when possible] were published on the departmental intranet for all anesthesia personnel.Subsequently, we identified a group of 7 faculty volunteers who later became the dedicated liver transplant anesthesia team. None of these individuals completed a formal transplant anesthesia fellowship, but 2 were

In our experience, administration of AP was not superior to TA with regards to blood loss and blood product transfusion requirement during OLT. In addition, we found no difference between the groups in the 1-year survival rate and renal function. Furthermore, we suggest that starting Hb concentration should be considered when prioritizing patients on the waiting list and planning perioperative care for OLT recipients.