Live Donor Liver Transplantation Without Blood Products

Jabbour, Nicolas; Singh, Gaurav; Mateo, Rod; Sher, Linda; Strum, Earl; Donovan, John A.; Kahn, Farrol; Peyré, Christian G.; Henderson, Randy; Fong, Tse‐Ling; Selby, Rick; Genyk, Yuri

doi:10.1097/01.sla.0000133352.25163.fd

Cited by 68 publications

(21 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In trauma, early identification of patients at risk of massive transfusion (MT) and implementation of a protocol to prepare transfusions, have been associated with improved survival(4). Conversely, in liver transplant it is anticipated that the majority of patients will undergo large blood product resuscitation; however, many patients may not require massive transfusion because liver transplantation in certain scenarios has become a virtually bloodless procedure(5). Therefore, risk stratification for bleeding in these patients can lead to more optimal utilization of the blood bank, and aid in patient education for anticipated postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation

Lawson

Moore

et al. 2017

Journal of Surgical Research

View full text Add to dashboard Cite

Introduction Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept, but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when employed for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for massive transfusion. Material and Methods Liver transplant patients had blood drawn prior to surgical incision and assayed via TEG. Pre-operative TEG measurements were collected in addition to standard laboratory coagulation tests. TEG variables including R-time (reaction time), angle, MA (maximum amplitude), and LY30 (clot lysis 30 minutes after MA) were correlated to red blood cell (RBC) units, plasma (FFP), cryoprecipitate (Cryo), and platelets (Plt) during the first 24 hours following surgery, and tested for their performance using a receiver operating characteristic (ROC) curve. Results 28 patients were included in the analysis with a median MELD (Model for End-Stage Liver Disease) score of 17; 36% received a massive transfusion. The TEG variables associated with MT (defined as ≥10 RBC units/24hr) were a low MA (p<0.001) and low angle (p=0.014). A high INR (International Normalized Ratio of prothrombin time) (p=0.003) and low platelet count (p=0.007) were also associated with massive transfusion. MA had the highest area under the curve (0.861) followed by INR (0.803). A MA of less than 47mm has a sensitivity of 90% and specificity of 72% to predict a massive transfusion. MA was the only coagulation variable that correlated strongly to all blood products transfused. Conclusion TEG MA has a high predictability of massive transfusion during liver transplantation. The use of TEG pre-operatively may help guide more cost effective blood bank preparation for this procedure as only a third of patients required a massive transfusion.

show abstract

Section: Introductionmentioning

confidence: 99%

Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation

Lawson

Moore

et al. 2017

Journal of Surgical Research

View full text Add to dashboard Cite

show abstract

“…Thus, in spite of many developments liver transplant procedures still require substantial support of blood components during and immediately after the surgical procedure. [3] In liver transplant cases, at majority of instances, it's difficult to predict the perioperative requirement of blood transfusion. [4] The primary objective of the present retrospective study was to analyze the perioperative usage of allogeneic blood components in live donor related orthotopic liver transplant recipients and liver donors in liver transplant procedures performed at our tertiary healthcare center.…”

Section: Introductionmentioning

confidence: 99%

Perioperative use of allogenic blood components in live-related donor orthotopic liver transplantation: A cross sectional study

Pandey¹,

Tiwari²,

Sharma³

et al. 2013

Asian J Transfus Sci

View full text Add to dashboard Cite

Background:In spite of many improvements that have reduced the blood component requirements, substantial numbers of transfusions are still needed in liver transplantation.Aims:The objective of the present study was to analyze the perioperative usage of allogenic blood components and predict the preoperative factors as predictors of red cell transfusion in live-related donor liver transplant recipients.Materials and Methods:The retrospective data on utilization of allogenic blood components were analyzed for a total of 150 liver transplant procedures. The data on utilization of blood components during surgery and till 48 hours of ICU stay was collected from the blood bank record and hospital information system (HIS).Results:Red cell concentrate was commonest blood component used in liver transplant recipient and most of the transfusion took place during surgery. During intraoperative period 92.7% (N = 139) of the cases utilized red cell components with the median number of five whereas in postoperative period only 38% (N = 57) of patients received blood with the median number of one. This study demonstrates that the preoperative hemoglobin and platelet count are the predictors of utilization of red cell concentrates during surgery. There were a total of 11 (7.3%) recipients who didn’t receive allogeneic blood transfusion in any form. Utilization of blood components was negligible among organ donors.Conclusion:Our study demonstrates the pattern and predictors of usage of allogeneic blood components in liver transplant recipients at a tertiary healthcare center in India.

show abstract

“…Uncontrolled bleeding leads to a combination of haemodilution, hypothermia, consumption of clotting factors, reduced oxygen delivery to tissues and resultant acidosis, which in turn exacerbates the clotting process further causing a vicious ‘bloody' circle. With advances in anaesthetic and surgical techniques, development of newer parenchymal transaction devices, vessel control instruments and haemostatic adjuncts, it should be possible to perform major liver resections and liver transplantation with minimal or no transfusion even in Jehovah's Witness patients [10,11,12]. With increasing safety, mortality rates as low as 1-2% in specialist centres have been reported [13].…”

Section: Introductionmentioning

confidence: 99%

Methods of Haemostasis During Liver Resection - A UK National Survey

et al. 2013

View full text Add to dashboard Cite

Background: Although haemorrhage is a major cause of morbidity and mortality in liver surgery, there is very little available guidance on its management. Methods: The aim of this study was to identify current practice in the UK in this regard. An online survey was created and hepatobiliary (HPB) specialists who were members of a specialist society and others who were known practitioners were invited by e-mail to complete the survey anonymously. Results: Fifty-one percent responded (n = 36/70), and most of these respondents worked at large HPB centres (>100 liver resections/year; n = 24, 66%). Not all questionnaires were fully completed by the individual surgeons. Thirty-eight percent of the surgeons routinely used Pringle's manoeuvre. Most surgeons used ligation of the inflow vessels (n = 16, 44%) and stapled the outflow vessels (n = 15, 42%). The Cavitron ultrasonic surgical aspirator (CUSA; 54%, 13/24) was preferred for parenchymal transection. The majority routinely used haemostatic adjuncts (n = 22, 62%), whilst 33% (n = 12) used them occasionally. Twenty-three (64%) felt manufactured haemostatic adjuncts played a major role in maintaining haemostasis and 19 preferred fibrin-based products. Conclusion: The Pringle manoeuvre is a popular technique amongst specialist UK liver surgeons and the CUSA is used by nearly half of the surgeons. Despite the absence of definitive evidence for their benefit, manufactured haemostatic adjuncts are still widely used, especially the fibrin-based adjuncts.

show abstract

Live Donor Liver Transplantation Without Blood Products

Cited by 68 publications

References 41 publications

Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation

Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation

Perioperative use of allogenic blood components in live-related donor orthotopic liver transplantation: A cross sectional study

Methods of Haemostasis During Liver Resection - A UK National Survey

Contact Info

Product

Resources

About