Click
here to close Hello! We notice that
you are using Internet Explorer, which is not supported by Echinobase
and may cause the site to display incorrectly. We suggest using a
current version of Chrome,
FireFox,
or Safari.
World J Hepatol
2013 Jan 27;51:1-15. doi: 10.4254/wjh.v5.i1.1.
Show Gene links
Show Anatomy links
Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation.
Feltracco P
,
Brezzi M
,
Barbieri S
,
Galligioni H
,
Milevoj M
,
Carollo C
,
Ori C
.
???displayArticle.abstract???
Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system, portal hypertension with multiple collateral vessels, portal vein thrombosis, previous abdominal surgery, splenomegaly, and poor "functional" recovery of the new liver. The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge, and, despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss, the requirements for blood or blood products remains high. The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome. Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated. Isovolemic hemodilution, the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion. The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications. In this article we report on the common preoperative and intraoperative factors contributing to blood loss, intraoperative transfusion practices, anesthesiologic and surgical strategies to prevent blood loss, and on intraoperative blood salvaging techniques and autologous blood transfusion. Even though the advances in surgical technique and anesthetic management, as well as a better understanding of the risk factors, have resulted in a steady decrease in intraoperative bleeding, most patients still bleed extensively. Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center. Unfortunately, despite the large number of OLTx performed each year, there is still paucity of large randomized, multicentre, and controlled studies which indicate how to prevent bleeding, the transfusion needs and thresholds, and the "evidence based" perioperative strategies to reduce the amount of transfusion.
,
Autologous blood transfusions. Council on Scientific Affairs.
1986, Pubmed
,
Autologous blood transfusions. Council on Scientific Affairs.
1986,
Pubmed
Afshari,
Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion.
2011,
Pubmed
Alkozai,
Bleeding in liver surgery: prevention and treatment.
2009,
Pubmed
Ashworth,
Cell salvage as part of a blood conservation strategy in anaesthesia.
2010,
Pubmed
Bayly,
Reversal of post-reperfusion coagulopathy by protamine sulphate in orthotopic liver transplantation.
1994,
Pubmed
Blumberg,
Deleterious clinical effects of transfusion immunomodulation: proven beyond a reasonable doubt.
2005,
Pubmed
Bowley,
Intraoperative blood salvage in penetrating abdominal trauma: a randomised, controlled trial.
2006,
Pubmed
Boylan,
Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation.
1996,
Pubmed
Brajtbord,
Potential problems with autotransfusion during hepatic transplantation.
1989,
Pubmed
Brander,
Severe transfusion-related acute lung injury.
2005,
Pubmed
Buetens,
Prevalence of HLA antibodies in transfused patients with and without red cell antibodies.
2006,
Pubmed
Cacciarelli,
Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation.
1999,
Pubmed
Cardone,
Perioperative blood conservation.
2009,
Pubmed
Carless,
Cell salvage for minimising perioperative allogeneic blood transfusion.
2006,
Pubmed
Castelino,
Natural anticoagulants and the liver.
1997,
Pubmed
Catling,
Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood.
2008,
Pubmed
Cheema,
Cardiac function during orthotopic liver transplantation with venovenous bypass.
1995,
Pubmed
Connor,
Intraoperative autologous blood collection and autotransfusion in the surgical management of early cancers of the uterine cervix.
1995,
Pubmed
Dalmau,
The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: a comparative study.
2004,
Pubmed
Dalmau,
Tranexamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation.
2000,
Pubmed
Davis,
The use of cell salvage during radical retropubic prostatectomy: does it influence cancer recurrence?
2003,
Pubmed
Deakin,
Factors influencing blood transfusion during adult liver transplantation.
1993,
Pubmed
Devi,
Cloning, expression, purification, crystallization and preliminary X-ray diffraction analysis of the collagen-binding region of RspB from Erysipelothrix rhusiopathiae.
2010,
Pubmed
Dupont,
Liver transplantation without the use of fresh frozen plasma.
1996,
Pubmed
Fan,
Right lobe living donor liver transplantation with or without venovenous bypass.
2003,
Pubmed
Feltracco,
Microbiologic contamination of intraoperative blood salvaged during liver transplantation.
2007,
Pubmed
Feltracco,
Intensive care management of liver transplanted patients.
2011,
Pubmed
Fergusson,
A comparison of aprotinin and lysine analogues in high-risk cardiac surgery.
2008,
Pubmed
Ferrara,
Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion.
1990,
Pubmed
Findlay,
Aprotinin reduces red blood cell transfusion in orthotopic liver transplantation: a prospective, randomized, double-blind study.
2001,
Pubmed
Findlay,
Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables.
2000,
Pubmed
Freeman,
A randomized trial of solvent/detergent and standard fresh frozen plasma in the treatment of the coagulopathy seen during Orthotopic Liver Transplantation.
1998,
Pubmed
Gurusamy,
Piggy-back graft for liver transplantation.
2011,
Pubmed
Gurusamy,
Methods to decrease blood loss and transfusion requirements for liver transplantation.
2011,
Pubmed
Hannaman,
Anesthesia care for liver transplantation.
2011,
Pubmed
Hansen,
[Intraoperative blood salvage with irradiation of blood in cancer surgery -- answers to current queries].
2002,
Pubmed
Harper,
Protein C deficiency and portal thrombosis in liver transplantation in children.
1988,
Pubmed
Hendriks,
Blood loss in orthotopic liver transplantation: a retrospective analysis of transfusion requirements and the effects of autotransfusion of cell saver blood in 164 consecutive patients.
2000,
Pubmed
Hendriks,
Reduced transfusion requirements by recombinant factor VIIa in orthotopic liver transplantation: a pilot study.
2001,
Pubmed
Hendriks,
Intraoperative blood transfusion requirement is the main determinant of early surgical re-intervention after orthotopic liver transplantation.
2005,
Pubmed
Henry,
Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.
2011,
Pubmed
Hébert,
Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?
2001,
Pubmed
Innerhofer,
Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty.
2005,
Pubmed
Jabbour,
Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah's Witnesses.
2005,
Pubmed
Jabbour,
Impact of a transfusion-free program on non-Jehovah's Witness patients undergoing liver transplantation.
2006,
Pubmed
Kemper,
Cost analysis of intraoperative blood salvage during orthotopic liver transplantation.
1997,
Pubmed
Ker,
Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis.
2012,
Pubmed
Kerr,
Effects of acute liver injury on blood coagulation.
2003,
Pubmed
Khan,
Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients.
2007,
Pubmed
Kongsgaard,
Leucocyte depletion filter removes cancer cells in human blood.
1996,
Pubmed
Kopko,
Mechanisms of severe transfusion reactions.
2001,
Pubmed
Landis,
The antithrombotic and antiinflammatory mechanisms of action of aprotinin.
2001,
Pubmed
Lentschener,
A review of aprotinin in orthotopic liver transplantation: can its harmful effects offset its beneficial effects?
2005,
Pubmed
Li,
Acute respiratory distress syndrome after liver transplantation: etiology, prevention and management.
2002,
Pubmed
Liang,
Intraoperative blood salvage during liver transplantation in patients with hepatocellular carcinoma: efficiency of leukocyte depletion filters in the removal of tumor cells.
2008,
Pubmed
Lisman,
Recombinant factor VIIa improves clot formation but not fibrolytic potential in patients with cirrhosis and during liver transplantation.
2002,
Pubmed
Liu,
Requirements for transfusion and postoperative outcomes in orthotopic liver transplantation: a meta-analysis on aprotinin.
2008,
Pubmed
Liu,
Intraoperative management of liver transplant patients.
2011,
Pubmed
Liumbruno,
Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period.
2011,
Pubmed
Lodge,
Efficacy and safety of repeated perioperative doses of recombinant factor VIIa in liver transplantation.
2005,
Pubmed
Lutz,
Blood-transfusion requirements and blood salvage in donors undergoing right hepatectomy for living related liver transplantation.
2003,
Pubmed
Makwana,
Antifibrinolytics in liver surgery.
2010,
Pubmed
Mangus,
Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique.
2007,
Pubmed
Markiewicz,
Acute coagulopathy after reperfusion of the liver graft in children correction with recombinant activated factor VII.
2003,
Pubmed
Martell,
Physiopathology of splanchnic vasodilation in portal hypertension.
2010,
Pubmed
Massicotte,
Con: low central venous pressure during liver transplantation.
2008,
Pubmed
Massicotte,
Transfusion predictors in liver transplant.
2004,
Pubmed
Massicotte,
Reduction of blood product transfusions during liver transplantation.
2005,
Pubmed
Massicotte,
Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations.
2006,
Pubmed
Massicotte,
Evaluation of cell salvage autotransfusion utility during liver transplantation.
2007,
Pubmed
Massicotte,
Aprotinin versus tranexamic acid during liver transplantation: impact on blood product requirements and survival.
2011,
Pubmed
Massicotte,
MELD score and blood product requirements during liver transplantation: no link.
2009,
Pubmed
Miyamoto,
Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults.
2004,
Pubmed
Molenaar,
Efficacy and safety of antifibrinolytic drugs in liver transplantation: a systematic review and meta-analysis.
2007,
Pubmed
Molenaar,
Reduced need for vasopressors in patients receiving aprotinin during orthotopic liver transplantation.
2001,
Pubmed
Muscari,
Blood salvage autotransfusion during transplantation for hepatocarcinoma: does it increase the risk of neoplastic recurrence?
2005,
Pubmed
Nieder,
Intraoperative cell salvage during radical cystectomy does not affect long-term survival.
2007,
Pubmed
Niemann,
Recombinant factor VIIa reduces transfusion requirements in liver transplant patients with high MELD scores.
2006,
Pubmed
Ozier,
Institutional variability in transfusion practice for liver transplantation.
2003,
Pubmed
Palomo Sanchez,
Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation.
1998,
Pubmed
Pereboom,
Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury.
2009,
Pubmed
Phillips,
A prospective study investigating the cost effectiveness of intraoperative blood salvage during liver transplantation.
2006,
Pubmed
Planinsic,
Safety and efficacy of a single bolus administration of recombinant factor VIIa in liver transplantation due to chronic liver disease.
2005,
Pubmed
Porte,
Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study. EMSALT Study Group.
2000,
Pubmed
Pugliese,
Activated recombinant factor VII in orthotopic liver transplantation.
2007,
Pubmed
Ramos,
Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them.
2003,
Pubmed
Roberts,
The use of recombinant factor VIIa in the treatment of bleeding disorders.
2004,
Pubmed
Romero,
Infections in liver transplant recipients.
2011,
Pubmed
Roullet,
Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation.
2010,
Pubmed
Roullet,
Risk factors for bleeding and transfusion during orthotopic liver transplantation.
2011,
Pubmed
Sanjo,
Role of elevated platelet-associated immunoglobulin G and hypersplenism in thrombocytopenia of chronic liver diseases.
2003,
Pubmed
Sankarankutty,
Impact of blood salvage during liver transplantation on reduction in transfusion requirements.
2006,
Pubmed
Scholz,
Veno-venous bypass in liver transplantation: heparin-coated perfusion circuits reduce the activation of humoral defense systems in an in vitro model.
2001,
Pubmed
Schroeder,
Pro: low central venous pressure during liver transplantation--not too low.
2008,
Pubmed
Schroeder,
Intraoperative fluid management during orthotopic liver transplantation.
2004,
Pubmed
Sindram,
Platelets induce sinusoidal endothelial cell apoptosis upon reperfusion of the cold ischemic rat liver.
2000,
Pubmed
Steib,
Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict.
2001,
Pubmed
Sugai,
Current status of bacterial contamination of autologous blood for transfusion.
2001,
Pubmed
Sun,
The blockage of the high-affinity lysine binding sites of plasminogen by EACA significantly inhibits prourokinase-induced plasminogen activation.
2002,
Pubmed
Surgenor,
Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure.
2006,
Pubmed
Van Voorst,
Autotransfusion in hepatic transplantation.
1985,
Pubmed
Wang,
Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial.
2010,
Pubmed
Waters,
Modification of suction-induced hemolysis during cell salvage.
2007,
Pubmed
Waters,
An economic analysis of costs associated with development of a cell salvage program.
2007,
Pubmed
Waters,
Bacterial reduction by cell salvage washing and leukocyte depletion filtration.
2003,
Pubmed
Waters,
Indications and contraindications of cell salvage.
2004,
Pubmed
Wegner,
Clinical utility of thromboelastography: one size does not fit all.
2010,
Pubmed
Williamson,
Intraoperative autologous transfusion: its role in orthotopic liver transplantation.
1989,
Pubmed
Yank,
Systematic review: benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications.
2011,
Pubmed
Yuasa,
Intraoperative blood loss during living donor liver transplantation: an analysis of 635 recipients at a single center.
2005,
Pubmed
de Boer,
Minimizing blood loss in liver transplantation: progress through research and evolution of techniques.
2005,
Pubmed
de Boer,
The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation.
2008,
Pubmed
van der Hulst,
Veno-venous bypass without systemic heparinization using a centrifugal pump: a blind comparison of a heparin bonded circuit versus a non heparin bonded circuit.
1989,
Pubmed