*Purpose: Liver transplantation is often accompanied by significant blood loss and consequently a large consumption of blood products. In recent years, there has been a reduction in the consumption in uncomplicated cases, mainly due to improvement of surgical technique. Nevertheless, the number of complicated liver transplant patients, for example patients requiring graft reduction for size disproportion, combined transplantation or split graft recipients has been recently increasing. The utilization of blood products in these cases remains high and is associated with both higher morbidity and mortality. Transfusion of erythrocyte concentrates is associated with a higher incidence of infectious complications and thrombosis of hepatic artery. Fresh frozen plasma and thrombocyte concentrates may lead to circulatory overload, alloimmunization and acute lung injury.

*Methods: Based on our observation, one solution to reduce administration of transfusions is to use an autologous blood recuperation device Cell Saver. This method is a routine part of liver transplantation anesthesia care but its use remains controversial due to the activation of fibrinolysis by the collected erythrocytes. The consumption of blood products was retrospectively monitored in 20 liver transplantations between 2010 and 2015. The administration of blood products was recorded in patients on the day of transplantation and during the next 30 days following transplantation.

*Results: The average consumption of red blood cell products decreased by 25% perioperatively and by 10% postoperatively during the five-year period. Decrease in plasma consumption during the reference period was also observed. While in 2010, the administration of a larger volume of plasma was a standard part of the treatment protocol, in 2015 plasma was administered only infrequently to selected patients. Platelet consumption between 2010 and 2015 did not change significantly and remained relatively low.

*Conclusions: A number of factors play a role in decreasing consumption of blood products in liver transplantation. These include better preoperative optimization of patient, improved surgical technique, more prudent indication of transfusion administration, strictly individualized correction of coagulopathy using viscoelastic methods and based on our results specifically the use of Cell Saver. This trend is not only linked to a lower incidence of post-operative complications, but also reduces the demands on hospital transfusion department and therefore influences the economic impact of procedure.

« Back to 2020 American Transplant Congress