Effect of Restrictive Fluid Management and Acute Normovolemic Intraoperative Hemodilution on Transfusion Requirements During Living Donor Hepatectomy

Abstract

The aim of this study was to evaluate the safety and effectiveness of a restrictive fluid management strategy and acute normovolemic intraoperative hemodilution (ANIH) to decrease transfusion requirements among living-donors for liver transplantation (LDLT). We retrospectively reviewed the data of 114 consecutive LDLT donors. The patients were divided into 2 groups based on whether (Group I; n = 73) or not (Group II; n = 41) a restrictive fluid management strategy with ANIH was used during the procedure. For each group we recorded demographic features, intraoperative and postoperative transfusions, amount of administered intraoperative crystalloid and colloids, intraoperative hemodynamics, preoperative and postoperative laboratory values (renal and liver functions), intraoperative and postoperative urine output, and length of hospital stay. Demographic features and preoperative laboratory values were similar for the 2 groups, except for age (Group I, 36 ± 9 vs Group II, 33 ± 8; P = .04). Intraoperatively, 7 patients (10%) in Group 1 and 9 (22%) in Group II required blood transfusions ( P = .06). The respective amount of heterologous blood transfusion for Groups I and II was 96 ± 321 mL vs 295 ± 678 mL ( P = .06). Postoperative renal and liver functions were not different between the 2 groups ( P > .05). Patients in Group I had a shorter hospital stay than those in Group II (8.2 ± 4.6 days vs 10.1 ± 4.9 days; P = .03). In conclusion, a restrictive fluid management strategy with ANIH was a safe blood-salvage technique for LDLT. This approach was also associated with decreased length of hospital stay and a trend toward decreased transfusion requirements.