Orthotopic liver transplantation is one of the greatest challenges faced by the anesthesiologist, therefore, the importance of a correct pre-anesthetic assessment, in order to bring the patient to the most optimal level possible, based on the clinical characteristics that This can present as a result of the different pathophysiological changes that liver disease entails in multiple systems: neurological, pulmonary, cardiac, renal, coagulation status, fragility, and nutritional status. In addition, it will allow a correct staging of both the disease and the risks related to the surgical act, in order to be able to designate the best strategy adapted to the particular needs of each patient.

Transfusion of blood products in orthotopic liver transplantation (OLT) significantly increases post-transplant morbidity and mortality and is associated with reduced graft survival. Based on these results, an active effort to prevent and minimize blood transfusion is required. Patient blood management is a revolutionary approach defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment. This approach is based on three pillars of treatment: (1) detecting and correcting anemia and thrombocytopenia, (2) minimizing iatrogenic blood loss, detecting, and correcting coagulopathy, and (3) harnessing and increasing anemia tolerance. This review emphasizes the importance of the three-pillar nine-field matrix of patient blood management to improve patient outcomes in liver transplant recipients.