Minimizing Blood Loss in Liver Transplantation: Progress through Research and Evolution of Techniques

Abstract

Blood loss during liver transplantation has long been recognized as an important cause of morbidity and, especially in the early days, also mortality. It is well known that blood transfusions are associated with an increased risk of postoperative complications, such as infections, pulmonary complications, protracted recovery, and a higher rate of reoperations. Many studies have been performed during the past decades to elucidate the mechanisms of increased blood loss in liver transplantation. In the late 1980s, primary hyperfibrinolysis was identified as an important mechanism of bleeding during liver transplantation. This has provided the scientific basis for the use of antifibrinolytic drugs in liver transplant recipients. Several randomized, controlled studies have shown the efficacy of these compounds in reducing blood loss and transfusion requirements during liver transplantation. In addition, increasing experience and improvements in surgical technique, anesthesiological care and better graft preservation methods have contributed to a steady decrease in blood transfusion requirements in most liver transplant programs. Several centers are now reporting liver transplantation without any need for blood transfusion in up to 30% of their patients. Despite these improvements, most patients undergoing liver transplantation still require blood transfusions that have a negative impact on outcome, emphasizing the need for further attempts to control blood loss by surgeons and anesthesiologists. This paper provides an overview of the clinical and research developments, which have contributed to a reduction in blood loss and transfusion requirements, resulting in an important reduction in morbidity and mortality after liver transplantation during the last two decades.

Bleeding in Liver Surgery: Prevention and Treatment

“…It can be achieved by a restrictive use of fluid and blood products, avoidance of fluid overload, and no routine correction of abnormal coagulation tests by infusion of FFP or other large-volume blood products. 2,4,31 Although a low CVP is associated with reduced blood loss, it also carries a higher risk for complications such as air embolism, systemic tissue hypoperfusion, and renal failure. 2,30,34,35 Schroeder and colleagues 34 studied the safety of a fluid restriction policy and low CVP in liver transplant recipients by comparing outcome variables in two centers with different policies.…”

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

“…1 Yet the possibility of major intraoperative blood loss and the subsequent transfusion of large amounts of blood products still pose a real concern. After revising the transfusional chart of 758 consecutive transplanted adult patients we verified that 17.9% of OLT procedures required more than 11 red blood cell (RBC) units.…”

Critical Care Management after Adult Liver Transplantation

“…Ancak KT'de kan ürünleri [ES, TDP , trombosit süspansiyonu (TS)] transfüzyonunun artmış morbidite/ mortalite [transfüzyonla ilişkili akut akciğer hasarı (TRALI), enfeksiyon, HAT vb. oranlarında artış] ve yeniden yoğun bakıma yatışla ilişkili olduğunu gösteren birçok kanıt vardır (65)(66)(67)(68)(69)(70)(71). Bu yüzden son kılavuzlarda kan ürünlerinin kullanımı oldukça kısıtlanmıştır.…”