title: Intraoperative blood and fluid administration differences in primary liver transplantation versus liver retransplantation.
abstract: OBJECTIVE
  Liver retransplantation (Re-LT) is the effective therapy for irreversible liver graft failure after primary liver transplantation (LT). The challenges faced by the operative team in the Re-LT setting have been seldom elucidated. Our aim is to analyze the differences in fluid management in primary LT and Re-LT during the surgical procedure.
  
  
  METHODS
  The anesthesia charts of 16 patients who underwent both primary LT and Re-LT at our center in the space from October 1995 to May 2009 were analyzed. Group 1 (GI) consisted of patients who underwent primary LT, whereas patients in Group 2 (GII) were patients in GI but underwent Re-LT. GI was further divided into two subgroups depending on whether they had previous abdominal surgery before primary LT (GIB) or not (GIA). Wilcoxon signed-ranks test was used to compare GI and GII, and GIA and GIB. A p value less than 0.05 was regarded as significant. Data were given as mean ± standard deviation.
  
  
  RESULTS
  Blood loss was significantly increased from 48.9 ± 106 mL/kg in GI to 251.5 ± 242 mL/kg in GII. Consequently more blood products, crystalloids, sodium bicarbonate, calcium chloride, and neosynephrine were required to support the hemodynamics in GII. In GI, GIB tended to bleed more and required more blood transfusions than GIA.
  
  
  CONCLUSIONS
  More bleeding is expected in Re-LT than primary LT. Additional anesthetic personnel, more intravenous lines, and blood and blood products should be readily available to deal with the emergent fluid and hemodynamic resuscitations in anesthesia for Re-LT.
authors: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors: Sheng-Chun
authors: SC
authors: Yang
authors: Chao-Long
authors: CL
authors: Chen
authors: Chih-Hsien
authors: CH
authors: Wang
authors: Chia-Jung
authors: CJ
authors: Huang
authors: Kwok-Wai
authors: KW
authors: Cheng
authors: Shao-Chun
authors: SC
authors: Wu
authors: Bruno
authors: B
authors: Jawan
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation