Liver resection without blood transfusion

Gozzetti, G; Mazziotti, Alighieri; Grazi, Gian Luca; Jovine, Elio; Gallucci, A.; Gruttadauria, Salvatore; Frena, Antonio; Morganti, M.; Ercolani, Giorgio; Masetti, Michele; Pierangeli, Filippo

doi:10.1002/bjs.1800820833

Cited by 139 publications

(105 citation statements)

References 27 publications

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“…Mariette et al 22 demonstrated that age was significantly associated with the need for transfusion because elderly patients have poor tolerance for anaemia. Gozzetti et al 17 reported that serum albumin and bilirubin levels were significantly correlated with the need for blood transfusion during resection for HCC arising in the cirrhotic liver.…”

Section: Discussionmentioning

confidence: 99%

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

Itamoto

Katayama

Nakahara

et al. 2003

British Journal of Surgery

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Background: Preoperative autologous blood donation has been suggested for patients with liver disease who are to undergo liver resection. The aim of this retrospective study was to clarify the risk factors for increased blood loss and the need for blood transfusion during hepatectomy for hepatocellular carcinoma (HCC).Methods: From January 1996 to December 2000, 206 consecutive patients, 98·5 per cent of whom had underlying liver disease, underwent elective hepatectomy for HCC.Results: Major hepatectomy was performed in 34 patients (16·5 per cent) and minor hepatectomy in 172 patients (83·5 per cent). The mean blood loss was 410 (median 260) ml. Eleven (5·3 per cent) of the 206 patients received blood transfusion during or after the operation. Operation time (P = 0·004) and central venous pressure (CVP) (P = 0·041) were independently correlated with blood loss of more than 1000 ml. Only preoperative haemoglobin level (P = 0·001) was independently correlated with the need for blood transfusion. Conclusion:In patients with underlying liver disease, maintaining CVP at a level below 5 cmH 2 O during parenchymal transection to reduce blood loss is more important than reserving autologous blood before the operation.

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Section: Discussionmentioning

confidence: 99%

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

Itamoto

Katayama

Nakahara

et al. 2003

British Journal of Surgery

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“…9 In addition, bleeding and blood transfusion are risk factors for postoperative morbidity and in some reports, long-term cancer recurrence. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Furthermore, blood products are sometimes scarce and associated with appreciable expense. Thus, there is compelling rationale to reduce blood loss and blood transfusion as much as possible in patients undergoing liver resection.…”

Section: Introductionmentioning

confidence: 99%

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Karanicolas

Lin

Tarshis

et al. 2016

HPB

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“…Reductions in blood loss and consequent decreases in transfusion requirements have been shown to improve outcomes in patients undergoing liver resection for tumors. 9 Despite its well-documented benefits, IIO has not been adopted by most transplant centers performing LDLT. 10 We evaluated the role of IIO in living donor hepatectomy and compared our findings to results in an historic series of similar procedures performed without IIO.…”

Section: Introductionmentioning

confidence: 99%

Intermittent inflow occlusion in living liver donors: Impact on safety and remnant function

et al. 2004

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Clamping of the portal triad accomplishes complete inflow occlusion. This maneuver is commonly used during liver surgery to minimize blood loss but is not widely used in living donors undergoing resection for liver transplantation. We compared outcomes in living donors who underwent resection with and without inflow occlusion. We reviewed data on 2 nonsimultaneous living liver donor cohorts. The first 20 donors (group 1) underwent resection without inflow occlusion. In the next 15 donors (group 2), inflow occlusion was used during parenchymal transection, using cycles of 10 -15 minutes occlusion and 6 minutes reperfusion. In donors, we recorded type of resection; ischemia times; blood loss; transfusions; peak ALT, AST, bilirubin, and INR in the first 5 days; hospital length of stay (LOS), and major complications. In recipients, we recorded peak ALT. In group 1, 19 of 20 donors underwent right hepatectomy. In group 2, 8 donors underwent right hepatectomy, and 7 donors had left lobectomies. Total ischemic time ranged from 16 -49 minutes (mean, 31 ؎ 9 minutes). In group 1, two donors received a total of 5 U of allogeneic blood. In group 2, no donor required transfusion. Mean peak ALT was significantly higher in group 1 (521 ؎ 336 U/L) than group 2 (322 ؎ 162 U/L; P ‫؍‬ 0.03). Mean INR was significantly higher in group 1 (1.8 ؎ 0.2) vs. group 2 (1.5 ؎ 0.2; P ‫؍‬ 0.001). There were 4 major complications in group 1 (incisional hernia, transient liver failure, biliary stricture, and biliary leak) and no major intraoperative or postoperative complications in group 2. Mean LOS was significantly longer in group 1 (7.9 ؎ 2.9 days) than group 2 (6.2 ؎ 1.1 days; P ‫؍‬ 0.04). Mean peak ALT in recipients trended lower in group 2. In conclusion, inflow occlusion was associated with reduced blood loss and less ischemic injury to hepatic remnants in the donors and the grafts in the recipients. These benefits were associated with a diminished incidence of major complications and shorter LOS. Inflow occlusion should be an essential part of living donor hepatectomy. (Liver Transpl 2004;10:244 -247.)

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Liver resection without blood transfusion

Cited by 139 publications

References 27 publications

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Intermittent inflow occlusion in living liver donors: Impact on safety and remnant function

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