title: Liver transplantation and risk of bleeding.
abstract: OBJECTIVE
  Blood loss in orthotopic liver transplantation has declined during the past decade. Recent papers addressed this issue and emphasized its importance, because there is a significant correlation between intraoperative blood transfusion requirements and postoperative morbidity. This review addresses changes in practice that might have led to reduced blood loss.
  
  
  RESULTS
  Many preoperative variables that predict blood loss during orthotopic liver transplantation have been found. These vary between studies. Differences in perioperative blood loss, transfusion criteria and intraoperative management of coagulation may account for the interhospital variations in transfusion of red blood cells during orthotopic liver transplantation. Therefore, a risk index developed in one centre should not be applied without evaluation in other centres. Introduction of the piggyback technique and close monitoring of coagulation with thromboelastography have led to reduced blood transfusion requirements. Use of antifibrinolytics has shown to decrease blood loss. Recombinant factor VIIa is not indicated for treatment of coagulation abnormalities during orthotopic liver transplantation, and its use is justified only as rescue therapy.
  
  
  CONCLUSIONS
  Recent changes in blood conservation practices in orthotopic liver transplantation are presented and discussed.
authors.affiliation: aDepartment of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, RotterdambDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, GroningencDepartment of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Theo Hn
authors.initials: TH
authors.lastname: Groenland
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar