Korean J Transplant.  2022 Nov;36(Supple 1):S194. S194.

Intraoperative management of coagulation disturbances, replacement of blood, blood products and fluid management during living donor liver transplantation

• Khuvtsagaan B
• Regjii B
• Donkhim C
• Dorjbal EA
• Sanjaadorj O
• Amgaa T
• Lundeg G

• KMID: 2535710
• DOI: http://doi.org/S194

Abstract

Background
Intraoperative blood loss and coagulopathy is a common consequence of pre-existing abnormalities of the hemostatic system in living donor liver transplantation (LDLT). Estimated amount for fluid management and blood transfusion are challenging and unpredictable for recipient.
Methods
The patients involved in this study were divided into two groups. In the first group 76 cases underwent LDLT from 2011 to 2019 and in the second group included 85 recipients which operated after 2019. The data such as coagulation factors, blood, blood products and fluid used during LT and compared whether there are any correlations or relationships between two groups.
Results
In the first group there is an operation time of 16.4±4.12 hours, Intraoperative fluid replacement measured as 28.56±18.44 liters. In the second group, the average operation time continued 14±3.06 hours and the amount of intraoperative fluid replacement consisted of 19.9±6.4345 L. There is observable reduction in operation time and intraoperative fluid replace-ment in the second group. There is no significant difference between the groups on transfused blood products and in the sec- ond group used slightly more PRBC of 2.56±1.60 L whereas in the first groups was 1.54±1.86 L.
Conclusions
This retrospective study shows that the operation time reduced significantly in the second group. Due to frequent surgery performances enhanced and strengthened the surgeons experience and skill which led to reduction of operation time significantly and easened the potential technical difficulties. Monitoring and determining of coagulation factors by using coagulation, point-of-care testing and ROTEM enabled the transfusion of the blood, blood products and fluid at the right time during LDLT that definitely lead to increased success rate of surgery. The reason for the increased usage of PRBC in the second group was due to clinical conditions of patients which major policy change in National Health Insurance gave an opportunity to perform LDLT in more severe cases in Mongolia.