Transfusion autologue par recueil peropératoire pendant les transplantations orthotopiques du foie

Abstract

As large quantities of blood are required during orthotopic liver transplantation, intraoperative autotransfusion is therefore often carried out in adult patients. This study aimed to assess the ease of use of this technique, its efficiency and possible side-effects. Intraoperative blood salvage was carried out using a Cell Saver 4 R (Haemonetics) in 14 patients. The shest blood was collected, anticoagulated with heparin and sodium citrate, centrifuged and washed with Ringer lactate. During surgery, and the subsequent 5 days, the following data were recorded : red cell and platelet count, haemoglobin concentration, parameters of renal function, potassium, citrate and fibrinogen levels, parameters of renal function, blood cultures and the extubation delay. Autotransfusion was simple to use, with no side-effects during the procedure. An average of 20.5 red cell packs were required, of which 59.2 ± 2.3 % were supplied by autotransfusion. The volume of transfused blood was similar, or inferior, to other studies. The different haematological parameters, blood gases and serum potassium levels remained stable. Only 4 ± 2.8 red cell packs were required postoperatively to maintain a stable haematocrit value. There was no increase in thrombin time, and therefore no effect due to the used heparin. Citrate levels were correlated with the amount of autotransfused blood. They were lower than in other studies because autotransfusion limited the citrate load. There was no haemolysis. Postoperative renal function remained normal. There was no change in the blood coagulation profile, except when large volumes were transfused, resulting in a dilutional coagulopathy. Extubation was always carried out during the first two postoperative days. Bacteriological studies remained negative, no bacteraemia being noted. During orthotopic liver transplantation autotransfusion is a simple, reliable technique, with few side-effects.