Haemostatic disorders during liver transplantation

Area of Science:

• Anesthesiology
• Hepatology
• Hematology

Background:

• Liver transplantation presents significant coagulation challenges due to underlying liver disease and surgical stress.
• Increased intraoperative bleeding, often linked to hyperfibrinolysis, is a common complication.
• Existing preoperative coagulation assessments have limited predictive value for blood loss.

Purpose of the Study:

• To review the complexities of coagulation disorders in liver transplantation.
• To evaluate the efficacy of preoperative correction of coagulation defects.
• To discuss the need for effective intraoperative coagulation monitoring.

Main Methods:

• Literature review of coagulation disorders in liver transplantation.
• Analysis of preoperative coagulation testing and its predictive capabilities.
• Assessment of antifibrinolytic therapy and intraoperative monitoring techniques.

Main Results:

• Preoperative coagulation disorders are multifactorial and difficult to predict.
• Preoperative correction of coagulation defects has not demonstrably reduced intraoperative bleeding.
• The role and effectiveness of intraoperative coagulation monitoring remain controversial.

Conclusions:

• Coagulation management in liver transplantation is complex and requires careful consideration.
• Reliable methods for intraoperative coagulation monitoring are needed to guide transfusion strategies.
• Further research is necessary to establish evidence-based guidelines for coagulation management during liver transplantation.