摘要
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.
Liver transplantation has been associated with massiveblood loss and considerable transfusion requirements.Bleeding in orthotopic liver transplantation is multifactorial.Technical difficulties inherent to this complex surgicalprocedure and pre operative derangements of the primaryand secondary coagulation system are thought tobe the principal causes of perioperative hemorrhage.Intraoperative practices such as massive fluid resuscitationand resulting hypothermia and hypocalcemia secondaryto citrate toxicity further aggravate the preexistingcoagulopathy and worsen the perioperative bleeding.Excessive blood loss and transfusion during orthotopicliver transplant are correlated with diminished graftsurvival and increased septic episodes and prolongedICU stay. With improvements in surgical skills, anesthetictechnique, graft preservation, use of intraoperative cellsavers and overall perioperative management, orthotopicliver transplant is now associated with decreased intraoperative blood losses. The purpose of this review isto discuss the risk factors predictive of increased intraoperative bleeding in patients undergoing orthotopic livertransplant.
