Blood loss during liver transplantation in relation to the patient’s clinical state

Introduction
Liver transplant is a definitive treatment of end-stage liver insufficiency. The clinical state and biochemical parameters used for grading liver insufficiency can influence the functioning of the coagulation system and the amount of intraoperative blood loss.

Aim of the study
The aim of the study was to assess the influence of the clinical state and stage of liver insufficiency on blood loss during liver transplantation.

Material and methods
The study included 88 patients aged 19-67 years after liver transplantation at the Independent Public Regional Integrated Hospital in Szczecin, Poland. A retrospective analysis was carried out of data collected from liver transplantation qualification protocols, which contained social-demographic and epidemiological information.

Results
Average blood loss during liver transplantation amounted to 3082 ±2708 ml (range 400-16,000 ml). The average total surgery time was 371.21 min (range 255-405 min). Blood loss correlated with the model for end stage liver disease (MELD) and Child-Turcotte-Pugh score (CTP) values. However, an independent relationship with the amount of intraoperative blood loss was confirmed in the discriminant analysis only for three parameters, namely encephalopathy (p = 0.0032), poor dietary habits (p = 0.00107), and surgery duration (p = 0.00178).

Conclusions
Cachexia and encephalopathy constitute independent clinical factors of the increased risk of intraoperative bleeding. Surgery duration is an independent factor conditioning the amount of intraoperative blood loss.