Intraoperative blood loss in orthotopic liver transplantation: The predictive factors

Abstract

Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding. Excessive blood loss and transfusion during orthotopic liver transplant are correlated with diminished graft survival and increased septic episodes and prolonged ICU stay. With improvements in surgical skills, anesthetic technique, graft preservation, use of intraoperative cell savers and overall perioperative management, orthotopic liver transplant is now associated with decreased intra operative blood losses. The purpose of this review is to discuss the risk factors predictive of increased intra operative bleeding in patients undergoing orthotopic liver transplant.

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

“…Yet the consensus of anemia treatment with blood transfusion in patients undergoing transplant surgery had not been established. Although most medical institutions complied with the practice guideline of RBC transfusion with a threshold of Hb level at 6.0 to 10.0 g/dL, there was a wide variability of transfusion trigger among different centers (Pandey et al, 2015). In addition to the different timings and norms in initiating blood transfusion among transplantation surgery and health care teams, the baseline characteristics of transplanted populations contributed to the considerable variability of transfusion trigger and subsequent outcomes (McCluskey et al, 2006).…”

Pilot study of closed-loop anaesthesia for liver transplantation

“…8 The controller has been used in several controlled studies, particularly a study of routine surgical adult patients with better efficacy than manual control, 9 a study which aimed to assess the anaesthetic potency of nitrous oxide 6 in obese patients 8 and in a paediatric population. 10 Such a system needs to be studied during challenging anaesthetic contexts such as lung transplantation 11 and orthotopic liver transplantation (OLT), the latter combining haemodynamic variations, 12 major changes in circulating volume associated with clamping or haemorrhage, 13 and pharmacokinetic particularities of the anhepatic phase. 14 This pilot study aimed to test that our algorithm was able to maintain anaesthesia with a BIS value in the range 40-60 during at least 82% of the period of maintenance of anaesthesia, a figure obtained previously during routine surgical procedures (non-inferiority hypothesis).…”

Thromboelastometric Profile in Patients with Prothrombotic Risk Factors Undergoing Liver Transplantation

“…However, in spite of corrections with blood products, there was hypocoagulation in the thromboelastogram throughout the liver transplantation, corroborating with the blood loss, hemodilution and the consumption of coagulation factors that occur along the OLT [6,7,20].…”

“…Historically, OLT has been associated with transfusion of large amounts of blood derivatives [3][4][5][6][7]. Currently, there is a progressive reduction of perioperative blood loss due to advances in surgical skills, anesthetic management and coagulation monitoring in general [8][9][10][11][12].…”