Liver Transplantation

Liver transplantation presents some difficult challenges to a blood bank. Patients undergoing liver transplantation often require large amounts of all types of blood components in the perioperative period. Many of these patients have an abnormal coagulation status preoperatively and thus develop dilutional coagulopathy early with the transfusion of red cell products. In addition, after the recipient's liver has been removed, there is an anhepatic phase during which no coagulation factor synthesis occurs. During revascularization with the donor liver, an explosive fibrinolytic phase can occur. Aminocaproic acid or aprotinin have been used to attenuate bleeding from excessive fibrinolysis in this phase. In the

Table 12.2. Comparative median blood component use in association with solid

organ allograft

Organ

Red cells

Plasma

Platelets

Cryoprecipitate

Kidney

O

O

O

O

Liver

12

13

1O

O

Heart

4

S

1O

O

Lung:

Single

2

O

O

O

Double

l

2

8

O

(adapted from Tuiulzi, DJ. Transfusion Support in Solid Organ Transplantation; Eds. Reid ME, Nance SJ. Red Cell Transfusion, A Practical Guide, Humana Press Inc. Totowa, NJ)

(adapted from Tuiulzi, DJ. Transfusion Support in Solid Organ Transplantation; Eds. Reid ME, Nance SJ. Red Cell Transfusion, A Practical Guide, Humana Press Inc. Totowa, NJ)

postoperative setting, a hypercoagulable state has also been reported, which can result in thrombosis. Thus, in the earlier phase of this procedure, large numbers of red cells are required and, associated with this, the transfusion of plasma and/ or platelets. If fibrinogen levels drop precipitously low, cryoprecipitate may also be transfused. Liver transplantation, when first initiated, can be associated with the transfusion of more than 100 blood components/case. As experience is gained, however, the blood transfusion requirements frequently drop by more than two thirds. The indication for transplantation may also influence the transfusion requirements; those undergoing transplantation for primary biliary cirrhosis or carcinoma use fewer blood products than those with other diagnoses, such as scle-rosing cholangitis.

Patients with red cell alloantibodies often receive incompatible units of red cells early in the procedure, since they are subsequently shed during intraoperative bleeding and the more compatible red cells are transfused later in the procedure. This is in contrast to standard blood banking practice, where the most compatible blood would ordinarily be transfused first. CMV seronegative patients should receive CMV low risk products. Leukoreduction by filtration would appear optimal for these patients. As shown in Table 12.2, current blood use in liver transplantation can be considerable.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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