Haemostatic disorders during liver transplantation

Profound and complex coagulation disorders are encountered during liver tra nsplantation. They include preoperative coagulation disorders related to th e liver disease and haemostatic changes related to the procedure itself. Th ey commonly lead to increased intraoperative bleeding, especially due to in creased fibrinolysis, the contribution of which can be demonstrated by the relative efficacy of antifibrinolytics. Given the multifactorial nature of bleeding in liver transplantation, preoperative coagulation tests cannot pr edict blood loss even if some statistical relationship is occasionally foun d. Preoperative correction of coagulation defects has not been shown to be effective in reducing intraoperative bleeding. Throughout the procedure, a rapid and sensitive method for monitoring coagulation is necessary in order to guide the rational use of blood components and pharmacological agents. The usefulness of such a method to assist management of blood loss or blood component requirements is poorly documented and controversial.