Pandey CK, Singh A, Kajal K, Dhankhar M, Tandon M, Pandey VK, Karna ST. Intraoperative blood loss in orthotopic liver transplantation: The predictive factors. World J Gastrointest Surg 2015; 7(6): 86-93 [PMID: 26131330 DOI: 10.4240/wjgs.v7.i6.86]
Corresponding Author of This Article
Chandra Kant Pandey, MD, Senior Professor and Head, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India. ceekeypandey@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
Author contributions: Pandey CK collected the references, conceived the concept, wrote the manuscript, revised and did the editing works; Singh A, Kajal K, Dhankhar M, Tandon M, Pandey VK and Karna ST wrote the manuscript, revised and did the editing works; all the above authors contributed equally in writing the manuscript, revising and did the editing works.
Conflict-of-interest: We, the authors of the manuscript hereby testify that none of us have received fees for serving as a speaker/consultant/advisory board member for any of organization. None of the authors have received research funding from any organization. None of the authors own stocks and/or shares in their names or concerned organizations. None of the authors own any relevant patents.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chandra Kant Pandey, MD, Senior Professor and Head, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India. ceekeypandey@gmail.com
Telephone: +91-95-40946851 Fax: +91-11-26123504
Received: January 12, 2015 Peer-review started: January 15, 2015 First decision: March 20, 2015 Revised: April 13, 2015 Accepted: April 28, 2015 Article in press: April 30, 2015 Published online: June 27, 2015 Processing time: 163 Days and 24 Hours
Abstract
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.
Core tip: Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. The bleeding in orthotopic liver transplantation is multifactorial such as etiology and severity of liver disease, preexisting coagulopathy, previous abdominal surgeries, preoperative hematocrit, surgical techniques and methods of clamping, experience of surgical team, central venous pressure, the use of antifibrinolytics and procoagulants and use of point of care monitoring during the transplantation. The purpose of this review is to discuss the risk factors predictive of increased intra-operative bleeding in patients undergoing orthotopic liver transplant.
