Peri-operative blood component transfusion in orthotopic liver transplantation

Objective To investigate the peri-operative changes of coagulation function and effect of blood transfusion on the prognosis of patients after orthotopic liver transplantation(OLT). Methods Retrospective analysis of clinical data of 19 patients operated in our hospital between June 2002 and June 2003 was performed. All patients had Child-C preoperative hepatic function and abnormal coagulation tests. Coagulation factors and platelets were transfused preoperatively for replacement. During anhepatic phase, extracorporeal veno-venous bypass (EVVB) was established. Hemodynamics, coagulation function and the amount of blood loss were monitored. According to different coagulation function indexes of the pre-anhepatic, anhepatic and neohepatic phases during OLT, the corresponding blood components were transfused. Patients were divided into groups based on postoperative survival and the total volume of blood transfused. We analyzed the effect of all kinds of factors on operation and postoperative courses. Results Without significant differences in preoperative hepatic function , coagulation function and surgical procedure, the total volume of blood transfusion, the volume of erythrocyte and the volume of fresh frozen plasma transfused had significant independent association with postoperative survival with R=-0.7518(P0.01)、-0.7104(P0.01)、-0.5144(P0.05) respectively. The volume of blood transfusion in the death group was significantly higher than that in the survival group(P0.05). The survival rate of patients receiving less than 10000ml of blood was significantly higher than those receiving more than 10000ml(P0.05). None of the patients had CMV infection after blood transfusion or intracranial hemorrhage after OLT. Conclusion Monitoring the coagulation function during perioperative period,transfusing patients with appropriate components and using leukocyte-depleted blood components are important factors to ensure uneventful operation course, can effectively reduce the total volume of blood transfusion and postoperative complications.