Risk Factors Associated with Reoperation for Bleeding following Liver Transplantation

Thompson, Maxwell; Redden, David T.; Glueckert, Lindsey; Smith, Anthony; Crawford, Jack H.; Jones, Keith A.; Eckhoff, Devin E.; Gray, Stephen H.; White, Jared; Bloomer, Joseph R.; DuBay, Derek A.

doi:10.1155/2014/816246

Cited by 27 publications

(26 citation statements)

References 35 publications

(43 reference statements)

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“…In our series, the most common indication of early reoperation was postoperative hemorrhage followed by vascular flow complications. The rate of early reoperation due to bleeding (9.6%) is comparable with previous reported series in which the rate varied from 8% to 27% . Hemostatic balance is a concern for patients with liver failure and LT recipients .…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis

Elsabbagh

Girlanda

Hawksworth

et al. 2018

Clinical Transplantation

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Section: Discussionsupporting

confidence: 85%

“…Untreated, those complications can lead to graft failure and death . Reoperation is frequently required post‐LT (9.2% to 34%) to treat these severe complications …”

Section: Introductionmentioning

confidence: 99%

Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis

Elsabbagh

Girlanda

Hawksworth

et al. 2018

Clinical Transplantation

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“…Benson et al [16] reported a significant dose dependent association between transfusion of RBC, fresh frozen plasma (FFP) and platelets and post-operative infections. Number of RBC units transfused was predictive for re-operation post LT in one centre [17] , an event associated with high financial burden and excess mortality [18] . Mechanisms for poor outcomes and increased postoperative infection associated with RBC transfusion are not fully understood.…”

Section: Drivers For Transfusion-free Transplantationmentioning

confidence: 97%

“…The vasoactive effects of platelets may cause other negative systemic consequences such as pulmonary hypertension and haemodynamic disturbance. In one study platelet infusion was associated with reduced re-operation rates, a reminder that balancing risks of bleeding and side effects is a real clinical challenge [18,23] .…”

Section: Drivers For Transfusion-free Transplantationmentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. Core tip: Liver transplantation (LT) was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anaesthetic management and the use of point of care guided goal-directed haemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Increasing use of marginal grafts and transplantation of sicker recipients will continue to challenge perioperative care and transfusion practice. Inter-institutional variability suggests a current lack of clear guidance and limited application of the principles of patient blood management to LT.

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“…However, blood products are also critical for resuscitation and hemostasis in the coagulopathic bleeding patient. A conservative platelet transfusion strategy has been associated with increased risk for re‐operation due to bleeding . Platelets are also a key source of serotonin, which is important for liver regeneration …”

Section: Introductionmentioning

confidence: 99%