Korean J Transplant.  2022 Nov;36(Supple 1):S182. 10.4285/ATW2022.F-3084.

The retransplantation case which required a massive transfusion and fluid resuscitation

• Regjii B
• Khuvtsagaan B
• Donkhim C
• Dorjbal EA
• Amgaa T
• Muukhukh A
• Lundeg G

• KMID: 2535698
• DOI: http://doi.org/10.4285/ATW2022.F-3084

Abstract

Since 2011, we have performed 168 living donor liver transplantation (LDLT) at the First Central Hospital, of which two of them were retransplanted. A 35-year-old female, hepatitis virus B related LC and underwent LDLT in May 2019. The first LT surgery went well without any major complications. However, the patients clinical condition worsened due to sinusoidal obstructive syndrome. Therefore, orthotropic retransplantation was performed again in January 2020. At that time the patients body weight was 40 kg, Hb level 7.8 g/dL, severe coagulopathy and model for end-stage liver disease score calculated as 40. The retransplantation surgery lasted for 17 hours. Based on vital signs and laboratory results of Hb, Hct, ROTEM parameters of coagulation and other tests, we used a rapid infusion system to determine rate and amount of transfusion and infusions in intraoperative settings. Throughout this surgery, a large amount of transfusion was used, including 82 liters of plasmalyte; 8.2 liters (33 units) filtrated and irradiated pRBC; 13 L (65 units) of FFP; 4.3 L of 20% albumin, and 450 mL of cryoprecipitate. The amount of fluids and blood products reached 108 L in total. In addition, we used 0.6 g/kg/min of norepinephrine, 0.8 g/kg/min of epinephrine, and 1 unit/hr of vasopressin to sustain the patients vital signs. The kidney function during and after retransplantation was preserved. Following the completion of surgery, the patient stayed at an ICU on mechanical ventilation for 144 hours and was able to extubated. The patients clinical condition improved gradually and discharged on postoperative day 44. Retransplantation cases with high model for end-stage liver disease scores require a large amount of blood product and fluids, however, the rate and types of infusion therapy depend on patients clinical condition and vital signs. The appropriate dosage of vasopressors and effective replacement of blood products and fluid resuscitation are the key approach to maintain vital sings and protect organ functioning during the retransplantation.