title: Intraoperative blood loss in orthotopic liver transplantation: The predictive factors.
abstract: Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding. Excessive blood loss and transfusion during orthotopic liver transplant are correlated with diminished graft survival and increased septic episodes and prolonged ICU stay. With improvements in surgical skills, anesthetic technique, graft preservation, use of intraoperative cell savers and overall perioperative management, orthotopic liver transplant is now associated with decreased intra operative blood losses. The purpose of this review is to discuss the risk factors predictive of increased intra operative bleeding in patients undergoing orthotopic liver transplant.
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Chandra Kant
authors.initials: CK
authors.lastname: Pandey
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Singh
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Kajal
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Dhankhar
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Tandon
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Vijay Kant
authors.initials: VK
authors.lastname: Pandey
authors.affiliation: Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Sunaina Tejpal
authors.initials: ST
authors.lastname: Karna
keywords: Intraoperative blood loss; Liver disease; Liver transplantation