Haemostatic problems in liver surgery: A review

Abstract

Massive blood loss requiring allogenic blood product transfusion has been a major problem during liver resection and transplantation surgery. The transfusion of red blood cell units (RBCs) and plasma has been adversely linked to 1-year survival rates. In a series of 1 803 consecutive cases undergoing hepatic resection surgery, total blood loss and the number of liver segments resected were the only independent predictors of morbidity and mortality. Improved surgical and anaesthetic techniques have resulted in a dramatic reduction of blood product requirements during orthotopic liver transplantation (OLT) and liver resection surgery compared to historical controls. Recent publications report that between 17.5% and 81% of OLT operations and > 90% of hepatic resections can now be performed without red blood cell transfusions. In both groups, reduction in blood transfusions has led to improved outcome. Severe bleeding still occurs in a minority of cases and efforts to define clinical and blood test predictors for major bleeding during liver surgery remain elusive.