Blood loss in orthotopic liver transplantation: a retrospective analysis of transfusion requirements and the effects of autotransfusion of cell saverblood in 164 consecutive patients

Liver transplantation is associated with excessive blood loss. In order to identify factors influencing blood loss and to provide a basis for a pilot study to evaluate recombinant activated factor VII as a haemostatic agent, a retrospective study was performed in 164 consecutive patients with choles tatic or noncholestatic liver disease, who underwent orthotopic liver trans plantation at a single centre between 1989 and 1996. Transfusion of allogen eic and autologous (cell saver) blood was used as a measurement of blood lo ss. Transfusion requirements were associated with age, gender, primary dise ase, Child-Pugh classification, serum levels of activated partial thrombopl astin time, antithrombin III, urea and creatinine, platelet number, year of transplantation, length of cold ischaemia time and autologous blood transf usion. Of these variables, Child-Pugh classification (P = 0.001), urea (P = 0.0007), year of transplantation (P = 0.002), cold ischaemia time (P = 0.0 1) and autologous blood transfusion (P < 0.0001) were independent predictor s of transfusion requirements by multivariate analysis. Thus, blood loss an d transfusion requirements depend primarily on the severity of liver diseas e, quality of the donor liver, experience of the transplantation team and u se of autologous (cell saver) blood transfusion. These findings emphasize t he need for appropriate drug therapy and a critical reappraisal of current transfusion policy. Blood Coagul Fibrinolysis 11 (suppl 1):S87-S93 (C) 2000 Lippincott Williams & Wilkins.