Blood Product-Independent Liver Transplantation

Abstract

Since the first human liver transplantation by Thomas E. Starzl in 1963 this operation has been considered among the most difficult ones. One of the factors influencing outcome of the graft, patient survival, and cost of the procedure is the amount of blood products being used during liver transplantation. Between 1981 and 1985 the average use of blood products per patient during liver transplantation at the University Hospital of Pittsburgh, PA, was 25 units of red blood cells (RBCs), 24 units of fresh frozen plasma (FFP), 9 units of cryoprecipitates and 20 units of platelets. In some difficult cases several hundred units of blood products were required to treat one single patient. Thus keeping up with the requirements of liver transplantation can be a very demanding task for any blood bank. Although massive blood transfusion may still occasionally be required, the use of blood products during liver transplantation has declined in recent years due to several factors. We recently presented our own experience of blood requirements during liver transplantation. At the University Hospital of Bern median blood replacement has decreased from 9 RBCs per patient between 1991 and 1993 to a median of 3 RBCs per patient in the period from 1995 to 1998. Three patients out of 75 (4%) who had liver transplantation at our institution between 1991 and 1998 did not receive any perioperative blood products. Furthermore, 13 (17%) received no RBCs, 5 (7%) had no FFP, and 23 (30%) received no platelet-rich plasma. This review discusses the pathophysiology of patients with terminal chronic liver insufficiency with regard to their hematologic and cardiovascular condition during the intraoperative phases of orthotopic liver transplantation. The risk of giving blood products to these patients, the possible predictors of increased intraoperative blood loss, and some of the available options to limit the use of blood products are addressed.

Transient thrombopoietin peak after liver transplantation for end‐stage liver disease

“…However, the consistent peak values in the four patient groups as well as the low interassay variability suggest that serum is as good an analyte as plasma. The transfusion dependency of our patients was relatively high, considering that such devices as the rapid infusion system and other blood saving measures (Rieder et al, 1999) had not yet been introduced in the early 1990s. The survival time of transfused platelets of about 3 days (Murphy, 1996) probably does not account for the platelet increase at peak serum platelet levels.…”