Reducing transfusion requirements in liver transplantation

作     者：Ciara I Donohue Susan V Mallett 

作者机构：Royal Free Perioperative Research Group (RoFPoR)Department of AnaesthesiaRoyal Free London NHS Trust 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2015年第5卷第4期

页      面：165-182页

学科分类：10[医学] 

主　　题：Liver transplantation Transfusion Blood conservation Patient blood management Coagulation 

摘      要：Liver transplantation(LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical piggyback techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management(PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT.