This study examines factors associated with the performance of orthotopic liver transplantation (OLT) without red blood cell (RBC) transfusion.
Between January 1992 and December 1994, 306 primary OLTs were performed with recipients divided into two groups: group 1 patients (61 recipients, 20% of total) underwent transplantation without packed RBCs, and group 2 patients (245 recipients, 80% of cases) received a transfusion of at least 1 unit of RBCs during operation.
Recipients in group 1 compared with group 2 had less advanced liver disease (20% hospitalized and 48% Child's class C versus 58% hospitalized and 73% Child's class C, p < 0.01) and lower frequency of right upper quadrant surgery (13% versus 25%, p < 0.05). Group 1 recipients also had significantly higher preoperative hematocrits (38% versus 33%, p < 0.01), lower prothrombin times (15.4 versus 16.7 seconds, p < 0.001) and partial thromboplastin times (36.9 versus 42.2 seconds, p < 0.01), a greater proportion of patients transplanted by piggyback technique (87% versus 59%, p < 0.001), and shorter operative times (7.9 hours versus 9.2 hours, p < 0.001). Moreover, a greater percentage of patients underwent OLT without RBC transfusion in each successive year: 9% in 1992, 21% in 1993, and 31% in 1994 (p < 0.001). Logistic regression analysis showed the following factors to be independent predictors of OLT without RBC transfusion. Preoperative Hct, United Network of Organ Sharing status, piggyback technique, operative time, and year of transplantation.
OLT can be performed without transfusion of RBCs in recipients with less advanced liver disease, and surgical technique, along with increased experience by the transplant team, are important factors.
"With the improvement of surgical techniques and anesthesia practices, the amount of blood transfused has been dramatically reduced   . Some centers achieved avoidance of RBC transfusion in up to 40% of liver recipients    , and bloodless OLT has been reported in single cases and case series         . Also contributing to this trend is the increasing awareness of the hazards associated with blood transfusion in OLT   , which have been observed in patients receiving red blood cells, platelets and plasma products   . "
"In the past, this procedure had been associated with massive blood loss and significant mortality (Bontempo et al, 1985; Bismuth et al, 1987; Kirby et al, 1987). Advances in operative management, surgical technique and graft preservation have led to a reduction in transfusion requirements and posttransplant morbidity and mortality (de Boer et al, 2005), and OLT can now be safely undertaken in selected patients without blood product support (Cacciarelli et al, 1996; Detry et al, 2005). The haemostatic changes associated with each stage of liver transplantation have been well described (de Boer et al, 2005; Senzolo et al, 2006) and are summarised in Table III. "
[Show abstract][Hide abstract] ABSTRACT: Liver disease impacts on both primary and secondary haemostatic mechanisms and historically these changes were thought to underpin the bleeding diathesis. However, bleeding complications in patients with liver disease are unpredictable, with the majority of haemorrhagic episodes occurring as a result of porto-systemic varices. Thrombosis is an increasingly recognised complication and systemic hypercoagulability may contribute to the development of parenchymal extinction and accelerated hepatic fibrosis. Routine laboratory tests do not reliably predict the risk of haemorrhage and the optimal management strategy to avert potential bleeding complications is yet to be established. There may be a future role for global coagulation assays, such as thrombelastography and thrombin generation, in both stratifying the risk of bleeding and guiding management of these patients.
British Journal of Haematology 12/2009; 148(4):507-21. DOI:10.1111/j.1365-2141.2009.08021.x · 4.71 Impact Factor
"In the last decade, however, significant technical developments in transplantation surgical practices have occurred. Liver transplantation can now be performed with transfusion of 10 or fewer units, with up to 30% of the operations requiring no blood transfusions  . Biliary anastomoses without stents or T tubes have led to a striking reduction in the rate of biliary complications . "
[Show abstract][Hide abstract] ABSTRACT: The advent of effective antibacterial and antiviral prophylatic and therapeutic strategies has led to the emergence of opportunistic mycoses as a principal cause of infection-related mortality in organ transplant recipients. Candida and Aspergillus species have accounted for most invasive fungal infections in organ transplant recipients. Epidemiologic trends within the last decade, however, are notable for the emergence of mycelial fungi other than Aspergillus as increasingly important pathogens in these patients. This article reviews the epidemiology, clinical manifestations, pathogenetic basis, diagnosis, and management of invasive fungal infections after organ transplantation in context of emerging trends and new developments in these areas.
Infectious Disease Clinics of North America 04/2003; 17(1):113-34, viii. DOI:10.1016/S0891-5520(02)00067-3 · 2.73 Impact Factor
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