Liver transplantation and resection
Liver transplantation is confined to specialist centres familiar with the complex blood management problems that occur in these patients. Transfusion requirements have fallen greatly but substantial blood product support may still be needed because of preoperative coagulopathy due to liver disease, complex surgery with large blood losses and intra-operative coagulopathy with fibrinolysis that occurs during the anhepatic phase of the operation. Intra-operative blood salvage is important when there is major blood loss. Post-operatively, the risk of hepatic artery thrombosis may be reduced by avoiding over-transfusion with red cells and platelets. When a group O liver is transplanted to a group A or B patient, haemolytic anaemia may occur due to anti A or anti B antibodies produced in transplanted lymphoid tissue. Aprotinin is no longer used routinely, but at the discretion of the anaesthetist. Thromboelastography is commonly used as a guide to platelet and coagulation factor replacement.