Impact of blood salvage during liver transplantation on reduction in transfusion requirements

Abstract

Purpose:The aim of this study was to analyse the changes in transfusion requirements, in patients submitted to orthotopic liver transpantation from cadaveric donors, with the use of intraoperative red blood cell salvage (Cell Saver). Methods: Data from 41 transplants were analysed. Intraoperative blood loss was calculated from the cell salvage, suction and the swabs. The autologous and heterologous transfusions were recorded The red blood salvage was performed using the Cell Saver 5 System (Haemonetics).. For analysis the patients were divided in two groups: one that used the Cell Saver and another that didn´t. Results: The median age of the patients was 50 years and the main indication for liver transplantation was cirrhosis (35 cases -85.3%). The median blood loss was 8362 + 3994 ml (with the Cell Saver) and 10824 + 7002 ml (without the Cell Saver) and the median transfusion of heterologous packed red blood cells was 9,6 + 8 units (with the Cell Saver) compared to 22,3 + 21 units (without the Cell Saver). Conclusions: The Cells Saver has the potential to reduce the need for heterologous blood transfusion reducing the risks of transmissible diseases. Key words: Liver Transplantation. Cell Saver. Blood Transfusion. Liver Surgery. RESUMO Objetivo: O objetivo desse estudo foi analisar as mundanças na quantidade de transfusão necessária com uso doIntraoperative red blood cell salvage (Cell saver), em pacientes submetidos a transplante ortotópico de fígado, doador cadáver. Métodos: Foram avaliados dados de 41 pacientes submetidos a transplante de fígado. O sangramento foi calculado de acordo com débito do aspirador, compressas e captação do Cell saver. A reposição necessária foi avaliada de acordo com a quantidade de transfusão heteróloga e autóloga. Para análise dos dados os pacientes foram dividos em dois grupos: com e sem uso de Cell saver. Resultados: A mediana de idade foi 50 anos e principal indicação de transplante foi cirrose hepática com 35 casos (85,3%). A mediana de sangramento durante o procedimento cirúrgico 8362 + 3994 ml (com cell saver) e 10824 + 7002 ml (sem cell saver) e a mediana de transfusão de concentrado de hemácias heterólogo, durante o período de internação hospitalar 9,6 + 8 unidades (com cell saver) compar 22,3 + 21 unidades (sem cell saver). Conclusão: Uso de Cell Saver tem um potential para reduzir a quantidade de transfusão heteróloga, dimuindo o risco de transmissão de doenças.

Hemodynamic Optimization Strategies in Anesthesia Care for Liver Transplantation

“…The safety of cell-salvaging procedure has been widely demonstrated [81]. Use of intraoperative autologous transfusion resulted in conservation of RBCs and reduction in exposure to homologous blood and blood components [82,83]. Use of Cell Saver during OLT made it possible to recover up to 50% of blood loss [84].…”

Review of anesthesia in liver transplantation

“…Overall, 10e20 U red blood cells should be immediately available in the operating room, and the amount of blood loss and total fluid replacement should be accurately documented. 167 A rapid blood transfusion device 168 and cell saver 169,170 can help maintain hemodynamic stability and prevent hypothermia. Such prevention measures are necessary because hypothermia itself may cause coagulopathy, even in patients with normal coagulation profiles.…”

Liver transplantation: Advances and perioperative care

“…Intraoperative blood salvage and retransfusion of the autologous blood is a cost-effective method to reduce the need for allogenic red blood cells in OLT provided there are no contraindications to cell savage[52] and the centre is a high turnover (with a minimum of 80 cases of cell savage per year). [53]…”