Does aprotinin really reduce blood loss in orthotopic liver transplantation?

Groh, J.; Welte, M.; Azad, S.C.; Anthuber, M.; Haller, M.; Kratzer, M.A.

Seminars in Thrombosis and Hemostasis 19(3): 306-308


ISSN/ISBN: 0094-6176
PMID: 7689758
DOI: 10.1055/s-2007-994048
Accession: 030992629

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Complications in patients undergoing OLT, such as hemorrhagic events, are caused not only by surgical problems but also by the profound functional disturbances arising from hepatic insufficiency, which are at least partially cured by the procedure itself. Preoperative clotting data give insight only into the dysfunction of the explanted organ. Hence, we tried to perform a standardized, "goal-directed" anesthesiologic management in the perioperative phase in OLT, following strict indications for blood replacement according to diuresis, hemoglobin level, and hemodynamic parameters. We performed 200 OLTs in 185 patients, according to usual methods. The mean intraoperative fluid requirement was 884 ml of balanced salt solution, 8.1 units of RBC, and 9.4 units of FFP. During the first 24 hours postoperatively, an average of 2.4 units of RBC and 5.6 units of FFP had to be transfused. Currently, 170 of the 185 patients (91.9%) are alive and well. Our data demonstrate that a distinct reduction of transfusion rates in OLT is possible, neglecting clotting data and improving clotting function by avoiding hemodilution.