Evaluation of cell salvage autotransfusion utility during liver transplantation

Orthotopic liver transplantation (OLT) may be associated with massive blood loss and the need for allogenic blood product transfusions. Cell salvage autotransfusion (CS) is an attractive alternative to allogenic red blood cell (RBC) transfusion. However, controversy surrounds its usefulness during OLT; some studies stated that CS decreased transfusions of allogenic blood products and others stated that blood loss was increased. The aim of this study was to evaluate the efficiency of the CS during OLT.

After approval by the institutional ethics committee, a prospective survey was undertaken. A total of 150 consecutive OLTs were included in the study. Two groups of patients were formed. Period 1 included patients 1-75 with no CS use. Period 2 comprised patients 76-150 with systematic CS use.

Patients from both periods were comparable. CS was used in all cases in period 2, and there was enough salvaged blood to retransfuse 65% of these OLTs. The mean volume of retransfused blood was 338+/-339 ml. The transfusion rate did not change from period 1 to period 2. The mean number of RBC units transfused per patient was 0.4+/-0.9 vs 0.4+/-1.2 with 78.7% vs 81.3% of cases not receiving transfusion of any blood product. The threshold for RBC transfusions was the same. The length of surgery and blood loss were greater in period 2 than in period 1 (associated with the arrival of two junior surgeons), but the hemoglobin (Hb) value was also higher at the end of surgery (93.8+/-19.3 g/L vs 85.2+/-17.8 g/L, p<0.0001).

Despite increased blood loss in period 2, CS saved 21 g/L of Hb per patient or two RBC unit transfusions. As long as we cannot predict with accuracy which patients will bleed, we will continue to use the CS for all OLTs.