THE RELEVANCE OF PERIOPERATIVE COAGULATIO N PARAMETERS TO INDICATIONSFOR BLOOD-TRANSFUSION - ANALYSIS OF 300 LIVER TRANSPLANTATIONS

In the present study, a retrospective statistical analysis of laborato ry data, clinical data, and perioperative blood requirements from 300 primary orthotopic liver transplantations (OLT) is described. Methods. OLT was performed using established surgical techniques and total IV anaesthesia. Volume was substituted with red blood cells (RBC) and fre sh frozen plasma (FFP) according to haemodynamic data, haemoglobin, an d diuresis. Platelet counts, prothrombin time, activated partial throm boplastin time (aPTT), thrombin time, fibrinogen, and antithrombin III were registered but not used as indications for transfusions. Statist ics were performed using regression analysis and analysis of variance. Results. The mean intraoperative fluid requirement was 793 ml balance d salt solution, 7.1 units RBC, and 8.4 units FFP; pooled random donor platelets were give only once. During 24 h postoperatively, an averag e of 1.8 units RBC and 4.6 units FFP had to be transfused. Currently, 278 of the 300 patients (92.7%) are alive. There was no significant co rrelation between clotting data and intraoperative blood use; for post operative transfusion rates, the preoperative aPTT and postoperative p latelet counts had a significant correlation. Reviewing the basic dise ases of the patients, there were significant differences in coagulatio n status, but no differences in transfusion rates. Conclusion. Accordi ng to the data presented, indications for transfusions in OLT accordin g to clotting data are not valid, since these data do not correlate wi th the blood requirement. In addition, strategies for pretreatment of patients such as preoperative plasmapheresis are no longer justified w ith respect to possible side effects.