[Fluid management in orthotopic liver transplantation]

To investigate the influential factors of fluid management during orthotopic liver transplantation surgery.

Ninety-six patients scheduled for orthotopic liver transplantation were divided into two groups according to the liver function: the decompensatory group (Child-Pugh score C, n=50) and the compensatory group (Child-Pugh score A or B, n=46). According to the intraoperative bleeding amount, the compensatory group was further divided into subgroup A (< 2,000 ml) and subgroup B (> or = 2,000 ml). Plasma albumin concentration and the parameters of blood coagulation were measured before and after the surgery. The intraoperative bleeding amount and the amount of the blood products infused were recorded.

Before the surgery, prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly longer in decompensatory group than in compensatory group (both P<0.05); blood platelets (PLT) and fibrinogen were significantly lower in decompensatory group than in compensatory group (both P<0.05). After the surgery, there were no significant differences in PT, APTT, PLT, and fibrinogen between the two groups (all P>0.05). The amounts of the blood products infused intraoperatively in subgroup A were significantly lower than those in the decompensatory group (all P<0.05). There was no significant difference in the amount of the infused blood products between the subgroup B and decompensatory group (all P>0.05).

During orthotopic liver transplantation surgery, patients with decompensatory liver function, or those who suffered large amounts of intraoperative bleeding, need infusion of larger amount of blood products.