What is the role of blood transfusion in orthotopic liver transplantation (OLT)?

Updated: Apr 19, 2019
  • Author: Vanessa A Olcese, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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Answer

Answer

Liver transplantation has emerged as an increasingly successful treatment for patients with end-stage liver disease (ESLD). Orthotopic liver transplantation (OLT) is the replacement of a diseased liver with a healthy liver in the normal anatomic position. The operative procedure is extensive, complex, and technically challenging, with multiple vascular transections and anastomoses. In addition, the liver is an extremely vascular organ and extensive bleeding can occur in patients with portal hypertension due to ESLD.

Historically, significant blood loss at the time of liver transplantation has been treated with large allogeneic and autologous (cell saver) transfusions of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate. Drugs are given along with the blood products, to help correct metabolic and coagulation abnormalities.

Transfusions, however—especially large-volume transfusions—are associated with a range of complications. [1] Increased blood requirements in OLT are associated with a more frequent occurrence of sepsis, longer stays in the intensive care unit, a higher rate of severe cytomegalovirus infection, and higher rates of graft failure and patient mortality. However, it remains unclear whether these differences in outcome are related to the transfusion as an independent risk factor or the transfusion is a marker for a technically more difficult surgery.

The literature includes cases of orthotopic liver transplantation (OLT) performed without transfusion of any blood products and OLT performed safely without additional blood products if blood loss is limited to 1600-3400 mL.

Because of many transfusion-related complications, especially those from large-volume transfusions, alternative therapies and approaches to transfusion are being investigated in transplantation and other surgical fields.

For other discussions on liver transplantation, see the overview topics Liver Transplantation and Pediatric Liver Transplantation.

For patient education information, see the Liver, Gallbladder, and Pancreas Center and Hepatitis Center, as well as Cirrhosis and Liver Transplant.


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