What is the role of estrogen in minimizing blood loss during liver transplantation?

Updated: Apr 19, 2019
  • Author: Vanessa A Olcese, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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Conjugated estrogen administered just prior to surgery and just after graft reperfusion has been shown to decrease blood loss and transfusion requirements. A prospective, randomized trial of 30 OLT subjects demonstrated significant intraoperative decreases in RBC, FFP, and platelet transfusion requirements. [31] A retrospective report from the same group described significant decreases in PRBC, platelet, and FFP use after the administration of 100 mg of estrogen. [32]

Hypothesized mechanisms of action of estrogen in this setting include an increased platelet count secondary to an increase in thromboxane B2 and beta-thromboglobulin. Because actual mechanisms, half-life, optimal dosing, and morbid effects are not well understood, estrogen is not in mainstream use, nor is it standard of care.

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