Reduced transfusion requirements during major hepatic resection with use of intraoperative isovolemic hemodilution

BACKGROUND: Allogeneic blood transfusion during liver resection for maligna ncies has been associated with an increased incidence of tumor recurrence a nd decreased survival in some series, Isovolemic hemodilution (IH) has been utilized in cardiac, orthopedic, and major general surgery procedures to r educe the use of banked blood products, We therefore sought to determine th e safety and efficacy of IH during major hepatic resection in an adult popu lation, METHODS: Thirteen consecutive patients undergoing major hepatic resection w ith IH were compared with 13 age- and disease-matched controls. The disease s included metastatic colorectal adenocarcinoma (8 versus 9), hepatoma (2 i n each group) and other (3 versus 2); and the procedures included total (ri ght or left) hepatic lobectomy (8 versus 11), partial lobectomy (3 versus 1 ) and trisegmentectomy (2 versus 1), RESULTS: There was no significant difference in operating time, estimated b lood loss, fresh frozen plasma, platelets, amount of crystalloid or colloid infused between the two groups. There was no perioperative morbidity relat ed to IH, The use of IH resulted in a 60% reduction in mean packed red bloo d cells transfusion during major hepatic resection, Only 38% of patients un dergoing IH required packed red cells transfusion, whereas 77% of historica l control patients required allogenic transfusion. CONCLUSION: The use of IH reduces the need for homologous transfusion durin g major hepatic resection. IH is a safe technique during hepatic resection and is not associated with perioperative morbidity, Am J Surg. 1998;176:608 -611. (C) 1998 by Excerpta Medica, Inc.