Perioperative bleeding in patients undergoing liver transplantation

Area of Science:

• Hepatology
• Surgical Oncology
• Transplant Surgery

Background:

• Liver transplantation (LT) is a complex procedure historically associated with significant bleeding risks.
• Advances in surgical techniques and perioperative care have reduced blood product transfusions in LT.
• Despite progress, perioperative bleeding and transfusion remain critical factors influencing mortality, complications, and graft survival.

Purpose of the Study:

• To review current evidence on managing hemostasis in liver transplant recipients.
• To highlight the ongoing importance of bleeding risk assessment and management in LT.

Main Methods:

• Systematic review of recent literature on hemostasis and transfusion practices in LT.
• Analysis of factors influencing perioperative bleeding and transfusion requirements.
• Evaluation of current strategies for intraoperative blood loss reduction.

Main Results:

• Up to 79.6% of LTs are performed without blood product transfusion in experienced centers.
• Perioperative bleeding and transfusion are potent predictors of mortality, complications, and graft survival.
• No universally validated predictive model for transfusion requirements in LT exists.

Conclusions:

• Careful screening for bleeding risk factors in LT candidates is essential.
• Individualized strategies for reducing intraoperative blood loss are crucial.
• Optimizing hemostasis management remains vital for improving LT outcomes.