Perioperative normovolemic anemia is safe in pediatric living-donor liver transplantation.
BACKGROUND
Perioperative normovolemic anemia was applied in pediatric living-donor liver transplant (LDLT) recipients with the aim of reducing the use of blood products and decreasing transfusion-related risk.


METHODS
The anemic state was allowed to occur by replacing intraoperative blood and transudate loss with colloid solutions and a discriminate use of packed red blood cells. When blood transfusion was required, the amount of blood replacement was calculated to target a hemoglobin level not higher than 8 to 9 g/dL.


RESULTS
Forty-eight pediatric patients underwent LDLT. Their mean hemoglobin and hematocrit levels were maintained below 9 g/dL and 27%, respectively, at the end of the operation, at the time of extubation, postoperative days 3, 10, and 20, and at the time of discharge. The mean ventilatory support time was 15.7 hr, and no patient required reintubation. Graft function normalized within the first week posttransplant in all patients, and there was no documented case of acute hepatic artery thrombosis. All the patients were discharged with acceptable liver function, and 98% of them remain alive to date.


CONCLUSIONS
Routine application of perioperative normovolemic anemia in pediatric LDLT has allowed the sparing use of blood products. Approximately half of our patients (42%) did not require intraoperative blood transfusion; 31% of the patients went home without receiving any blood products except 5% albumin. There were no adverse effects with this maneuver, and graft function was good in all patients.
Jawan
Bruno
B
Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung, Kaohsiung, Taiwan. jawanb@hotmail.com
de Villa
Vanessa
V
Luk
Hsiang-Ning
HN
Wang
Chih-Shien
CS
Huang
Chia-Jung
CJ
Chen
Yaw-Sen
YS
Wang
Chih-Chi
CC
Cheng
Yu-Fan
YF
Huang
Tung-Liang
TL
Eng
Hock-Liew
HL
Liu
Po-Ping
PP
Chiu
King-Wah
KW
Chen
Chao-Long
CL
D000293:Adolescent; D000328:Adult; D000740:Anemia; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D006400:Hematocrit; D006438:Hemodilution; D006454:Hemoglobins; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D019990:Perioperative Care
D006454:Hemoglobins