ABSTRACT
BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.