Reply: Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations

Transfusion Rate for 500 Consecutive Liver Transplantations

“…The only two variables that were linked were starting Hb and the use of phlebotomy. Again, these results are still consistent with our previous reports (2,14,37,39). The mean intraoperative bleeding was still the sameVapproximately 1000 mLV throughout this large series, independently of severity of the patients' disease.…”

“…As demonstrated by our previous reports, our strategy was not deleterious to the postoperative creatinine value or the 1-year survival rate (2,14,37). Survival was not an outcome for this work, but the survival rate at 1 month was 94.1%, and at 1 year, the survival rate for the first 400 patients was 85.7%.…”

“…Monitoring was standardized in all patients, as was the anesthesia technique (pulmonary artery catheter, arterial catheter, sufentanil, propofol, and rocuronium) (2,14,29). In the absence of uncontrollable bleeding, coagulation disorders were not corrected before or at the time of transplantation.…”

“…A significant decrease in blood loss and blood product requirement has been observed during OLT over the past 10 years (2). This decrease can be explained by increasing experience, improvements in surgical and anesthetic techniques, and a better understanding of the various hemostatic abnormalities encountered during OLT.…”

Four-factor Prothrombin Complex Concentrate During Liver Transplantation: A Retrospective Cohort Study

“…Transfusion-associated circulatory overload and hypervolemia are especially problematic in patients with cirrhosis as relative fluid overload in the splanchnic venous system may increase central venous and portal venous blood pressures and trigger portal and splanchnic hypertension, a known risk factor for bleeding during OLT. 4,5 Four-factor prothrombin complex concentrate (PCC) is a plasma product containing 4 vitamin K-dependent factors (II, VII, IX, and X), protein C, and protein S in concentrations 25× greater than fresh frozen plasma. 1,6,7 Kcentra (CSL Behring, King of Prussia, PA) is the only Food and Drug Administration-approved 4-factor PCC in the United States and is currently Food and Drug Administration-approved for urgent reversal of acquired coagulopathy from vitamin K antagonism during major bleeding.…”