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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Oct 12

DOI: 10.23736/S0375-9393.17.12231-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Rational approach to transfusion in liver transplantation

Fuat H. SANER 1 , Lasitha ABEYSUNDARA 2, Matthias HARTMANN 3, Susan V. MALLETT 2

1 Department of General, Visceral and Transplant Surgery, Essen, Germany; 2 Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK; 3 Department of Anesthesia, Critical Care and Pain Service, Essen, Germany


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For over 50 years patients with liver cirrhosis were considered to be at markedly increased risk of bleeding. This dogma was seemingly supported by abnormalities in standard laboratory tests (SLTs), such as the prothrombin time, that were interpreted as indicating a bleeding diathesis. However, publications from the last decade have revealed SLTs to be poor predictors of bleeding and it is now understood that stable patients with cirrhosis have a rebalanced haemostatic system and preserved thrombin generation. Viscoelastic tests (VETs), such as ROTEM® or TEGTM allow dynamic assessment of the entire coagulation process and provide a better illustration of the interactions between pro- and anticoagulants as well as platelets. Despite their documented success in reducing transfusion rates in liver transplantation more than 30 years ago, the adoption of VETs has been met with some resistance and has only recently gained significant momentum. Bleeding risk should be assessed in every patient undergoing invasive intervention and must consider markers of disease severity, underlying coagulation incompetence, anaemia and surgical factors. The recognition that bleeding in this patient cohort is predominantly linked to mechanistic factors such as portal hypertension, rather than primary coagulopathy, has led to a paradigm shift in their peri-operative management. Cognizant of their detrimental effect, the use of large volumes of FFP to correct derangements in SLTs has given way to more refined haemostatic management with specific factor concentrates guided by VETs, coupled with measures to minimize portal venous pressure and meticulous surgical haemostasis.


KEY WORDS: Coagulation - Transfusion rate - FFP - Coagulation factor - Viscoelastic tests

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Publication History

Article first published online: October 12, 2017
Manuscript accepted: October 10, 2017
Manuscript revised: September 12, 2017
Manuscript received: June 12, 2017

Per citare questo articolo

Saner FH, Abeysundara L, Hartmann M, Mallett SV. Rational approach to transfusion in liver transplantation. Minerva Anestesiol 2017 Oct 12. DOI: 10.23736/S0375-9393.17.12231-5

Corresponding author e-mail

fuat.saner@uni-due.de